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ederal Trade Commissioi




www.actionweightloss.com
An Analysis of Current Trends




                 A FEDERAL TRADE COMMISSION
                 STAFF REPORT



                 September 2002
www.actionweightloss.com

            An Analysis of Current Trends




A REPORT OF THE STAFF OF THE FEDERAL TRADE COMMISSION


                             September 2002
FEDERAL TRADE COMMISSION

TIMOTHY J. MURIS, Chairman

SHEILA F. ANTHONY, Commissioner

MOZELLE W. THOMPSON, Commissioner

ORSON SWINDLE, Commissioner

THOMAS B. LEARY, Commissioner




        This report is a project of the staff of the Federal Trade Commission with the assistance of the
Partnership for Healthy Weight Management, a coalition of representatives from science, academia, the
health care profession, government, commercial enterprises, and organizations whose mission is to
promote sound guidance on strategies for achieving and maintaining a healthy weight. The principal
authors of this report are attorneys with the Bureau of Consumer Protection, Federal Trade Commission.
The views expressed in this report are those of the authors and do not necessarily represent the views of
the Federal Trade Commission or any individual Commissioner. Special thanks are given to members of
the Partnership, for their contributions to this report and to Michelle Rusk, an attorney with the Federal
Trade Commission, for her assistance in editing this report, and Devenette Cox, who managed the data
base for the report. The authors wish to acknowledge the contributions of Elizabeth Nichols, Eva Tayrose,
Steve Sawchuk, Trisa Wilkens and Michelle Reeve for their assistance in the collection and coding of the
advertisements reviewed in this report.




                                                      i
ii
iii
Introduction

                                  George L. Blackburn, M.D., Ph.D.

         As health care professionals, we are concerned about the epidemic of obesity: the relations
between excess body weight and such medical conditions as cardiovascular disease, hypertension,
type 2 diabetes, osteoarthritis, sleep apnea, and certain cancers (such as breast, ovarian, prostate
and colon) are well established. We are equally concerned about false and misleading claims in the
advertising of weight loss products and services. Many promise immediate success without the need
to reduce caloric intake or increase physical activity. The use of deceptive, false, or misleading
claims in weight loss advertising is rampant and potentially dangerous. Many supplements, in
particular, are of unproven value or have been linked to serious health risks.

         A majority of adults in the United States are overweight or obese. All told, they invest over $30
billion a year in weight loss products and services. These consumers are entitled to accurate, reliable, and
clearly-stated information on methods for weight management. They have a right to know if the weight
loss products they're buying are helpful, useless, or even dangerous.

        For this reason, the staff of the Bureau of Consumer Protection, Federal Trade Commission
(FTC), joined with the Partnership for Healthy Weight Management-a coalition of representatives
from science, academia, the health care professions, government agencies, commercial enterprises,
and public interest organizations--to collect and analyze weight loss advertising. The Partnership's
purpose is to promote sound guidance to the general public on strategies for achieving and
maintaining a healthy weight. This report by the FTC staff is a major advance in that direction.

        Evidence-based guidelines issued by the National Institutes of Health call for weight loss by
simultaneously restricting caloric intake and increasing physical activity. Many studies demonstrate
that obese adults can lose about 1 lb. per week and achieve a 5% to 15% weight loss by consuming
500 to 1,000 calories a day less than the caloric intake required for the maintenance of their current
weight. Very low calorie diets result in faster weight loss, but lower rates of long-term success.

        While exercise added to caloric restriction can help overweight and obese people achieve
minimally faster weight loss early on, physical activity appears to be a very important treatment
component for long-term maintenance of a reduced body weight. To lose weight and not regain it,
ongoing changes in thinking, eating, and exercise are essential. Behavioral treatments that motivate
therapeutic lifestyle changes can promote long-term success by helping obese individuals make
necessary cognitive and lifestyle changes.

       The public often perceives weight losses of 5% to 15% as small and insufficient even though
they suffice to prevent and improve many of the medical problems associated with weight gain,


                                                    iv
overeating, and a sedentary lifestyle. Many in the weight loss industry promise effortless, fast weight loss, then
support this misperception by bombarding Americans with spurious advertising messages touting
physiologically impossible weight loss outcomes from the use of unproven products and services. All
advertisers, whatever their choice of media--cable television, infomercials, radio,
magazines, newspapers, supermarket tabloids, direct mail, or commercial e-mail and Internet
websites--know that only those products and services that help people adopt lifestyles that balance caloric
intake with caloric output will prevent and treat the disease of obesity.

      For certain businesses (weight loss franchises, pharmaceutical firms, food companies, the dietbook
industry, makers of exercise equipment, suppliers of dietary supplements, to name a few)
these deceptive and misleading advertisements prevent the public from hearing their messages,
words that promote therapeutic lifestyle changes as advocated by professional societies and the
U.S. Department of Health and Human Services. Data indicate that at any given time, almost 70
million Americans are trying to lose weight or prevent weight gain. In 2000 they spent
approximately $35 billion on products they were told would help them achieve those objectives--
videos, tapes, books, medications, foods for special dietary purpose, dietary supplements, medical
treatments, and other related goods and services.

        As with cigarette smoking and alcohol abuse, false or deceptive advertising of weight loss
products and services puts people at risk. Many of the products and programs most heavily
advertised are at best unproven and at worst unsafe. By promoting unrealistic expectations and
false hopes, they doom current weight loss efforts to failure, and make future attempts less likely to
succeed. In the absence of laws and regulations to protect the public against dangerous or
misleading products, a priority exists for the media to willingly ascribe to the highest advertising
standards, i.e., those that reject the creation and acceptance of advertisements that contain false or
misleading weight loss claims.

         The public would be well served by becoming more knowledgeable about the evidence-
based guidelines, the scientifically-proven and medically-safe standards that underlie national public
health policy. When more people know what's important and realistic in achieving and maintaining a healthy
body weight, fewer will be inclined to waste their money, time, and effort on dangerous fads or miracle
cures. The staff of the FTC‟s Bureau of Consumer Protection has provided an analysis
of current trends in weight loss advertising. It is now up to the consumer and media to act in the
best interest of the public health.

George L. Blackburn, M.D., Ph.D.
S. Daniel Abraham Chair in Nutrition Medicine
Harvard Medical School, Boston, MA
Past President of The American Society for Clinical Nutrition,
North American Association for the Study of Obesity, and the
American Society for Parenteral and Enteral Nutrition

                                                       v
TABLE OF CONTENTS
Introduction .............................................................................................................. iv
Executive Summary ............................................................................................... vii

I. An Overview ........................................................................................................    1
        A. A Never-Ending Quest for Easy Solutions ............................................                            1
        B. The Role of Advertising for Weight-loss Products and Services ..........                                        2
        C. Weight Loss: A Multi-Billion Dollar Industry.....................................                               2
II. Collection Methodology and Coding ................................................................                     3
III. Analysis of Weight-loss Advertisements ........................................................                       5
        A. General Observations .............................................................................              5
        B. Media and Product Types ........................................................................                6
        C. Claims by Category................................................................................              7
                1. Consumer Testimonials .............................................................                     9
                2. Before/After Photos ....................................................................               11
                3. Rapid Weight-loss Claims..........................................................                     13
                4. Lose Weight Without Diet or Exercise ......................................                            14
                5. Lose Weight Permanently ..........................................................                     15
                6. No Matter How Many Times You Have Failed Before ..............                                         16
                7. Scientifically Proven/Doctor Endorsed ......................................                           17
                8. Money-back Guarantees ..............................................................                   18
                9. Safe/All Natural Claims .............................................................                  19
IV. Historical Comparison: 1992/2001 ...................................................................                  21
V. Regulatory Framework ....................................................................................              25
        A. Legal Standards Applicable to Weight-loss Advertising......................                                    25
        B. FTC Enforcement History .....................................................................                  25
        C. FDA Regulation of Weight-loss Products .............................................                           27
VI. Media Responsibility .......................................................................................          28
VII. Conclusion .......................................................................................................   30

Appendix A: Product List
Appendix B: Examples of Questionable Ad Claims From 2001 Sample




                                                                    vi
Executive Summary
         This report attempts to take a comprehensive look at weight loss advertising. The need to do so
is compelling. In the last decade, the number of FTC law enforcement cases involving weight loss
products or services equaled those filed in the previous seven decades. Consumers spend billions of
dollars a year on weight loss products and services, money wasted if spent on worthless remedies. This
report highlights the scope of the problem facing consumers as they consider the thousands of purported
remedies on the market, as well as the serious challenge facing law
enforcement agencies attempting to prevent deceptive advertising.

        According to the U.S. Surgeon General, overweight and obesity have reached epidemic
proportions, afflicting 6 out of every 10 Americans. Overweight and obesity constitute the second
leading cause of preventable death, after smoking, resulting in an estimated 300,000 deaths per
year. The costs, direct and indirect, associated with overweight and obesity are estimated to exceed
$100 billion a year.

        At the same time, survey data suggest that millions of Americans are trying to lose weight. The
marketplace has responded with a proliferating array of products and services, many promising
miraculous, quick-fix remedies. Tens of millions of consumers have turned to over-the-counter remedies,
spending billions of dollars on products and services that purport to promote weight loss. In the end, these
quick-fixes do nothing to address the nation‟s or the individual‟s weight problem, and, if anything, may
contribute to an already serious health crisis.

         Once the province of supermarket tabloids and the back sections of certain magazines,
over-the-top weight loss advertisements promising quick, easy weight loss are now pervasive in
almost all media forms. At least that is the impression. But are the obviously deceptive
advertisements really as widespread as they might appear watching late night television or leafing
through magazines at the local newsstand? To answer this and other questions, we collected and
analyzed a nonrandom sample of 300 advertisements, mostly disseminated during the first half of
2001, from broadcast and cable television, infomercials, radio, magazines, newspapers,
supermarket tabloids, direct mail, commercial e-mail (spam), and Internet websites. In addition, to
evaluate how weight-loss advertising has changed over the past decade, we collected ads
disseminated in 1992 in eight national magazines to compare with ads appearing in 2001 in the same
publications.

        We conclude that false or misleading claims are common in weight-loss advertising, and,
based on our comparison of 1992 magazine ads with magazines ads for 2001, the number of products
and the amount of advertising, much of it deceptive, appears to have increased
dramatically over the last decade.

        Of particular concern in ads in 2001 are grossly exaggerated or clearly unsubstantiated

                                                   vii
performance claims. Although we did not evaluate the substantiation for specific products and
advertising claims as part of this report, many of the claims we reviewed are so contrary to existing
scientific evidence, or so clearly unsupported by the available evidence, that there is little doubt that they
are false or deceptive. In addition to the obviously false claims, many other advertisements contain
claims that appear likely to be misleading or unsubstantiated.

          Falling into the too-good-to-be-true category are claims that: the user can lose a pound a
day or more over extended periods of time; that substantial weight loss (without surgery) can be
achieved without diet or exercise; and that users can lose weight regardless of how much they eat.
Also falling into this category are claims that a diet pill can cause weight loss in selective parts of the body or
block absorption of all fat in the diet. These types of claims are simply inconsistent with
existing scientific knowledge.

        This report catalogues the most common marketing techniques used in 300 weight loss
advertisements. Nearly all of the ads reviewed used at least one and sometimes several of the
following techniques, many of which should raise red flags about the veracity of the claims.

         Consumer Testimonials; Before/After Photos. The headline proclaimed: “I lost 46 lbs
in 30 days.” Another blared, “How I lost 54 pounds without dieting or medication in less than 6
weeks!” The use of consumer testimonials is pervasive in weight-loss advertising. One hundred and
ninety-five (65%) of the advertisements in the sample used consumer testimonials and 42%
contained before-and-after pictures. These testimonials and photos rarely portrayed realistic weight
loss. The average for the largest amount of weight loss reported in each of the 195 advertisements
was 71 pounds. Fifty-seven ads reported weight loss exceeding 70 pounds, and 38 ads reported
weight loss exceeding 100 pounds. The advertised weight loss ranges are, in all likelihood, simply
not achievable for the products being promoted. Thirty-six ads used 71 different testimonials
claiming weight loss of nearly a pound a day for time periods of 13 days or more.

        Rapid Weight-loss Claims. Rapid weight-loss claims were made in 57% of the
advertisements in the sample. In some cases, the falsity of such claims is obvious, as in the ad that
claimed that users could lose up to 8 to 10 pounds per week while using the advertised product.

        No Diet or Exercise Required. Despite the well-accepted prescription of diet and
exercise for successful weight management, 42% of all of the ads reviewed promote an array of
quick-fix pills, patches, potions, and programs for effortless weight loss and 64% of those ads also
promised fast results. The ads claim that results can be achieved without reducing caloric intake or
increasing physical activity. Some even go so far as to tell consumers “you can eat as much as you
want and still lose weight.”

        Long-term/Permanent Weight-loss Claims. “Take it off and keep it off” (long-
term/permanent weight loss) claims were used in 41% of the ads in the sample. In fact, the publicly

                                                       viii
available scientific research contains very little that would substantiate long-term or permanent
weight-loss claims for most of today‟s popular diet products. Accordingly, long-term or permanent
weight-loss claims are inherently suspect.

          Clinically Proven/Doctor Approved Claims. Clinically proven and doctor approved
claims are also fairly common in weight-loss advertisements, the former occurring in 40% and the
latter in 25% of the ads in the sample. Some of the specific claims are virtually meaningless. For
example, a representation such as, “Clinical studies show people lost 300% more weight even
without dieting,” may cause consumers to conclude mistakenly that the clinically proven benefits are
substantial, whereas, in fact, the difference between use of the product and dieting alone could be
quite small (1.5 lbs. vs. .5 lbs.). These claims do little to inform consumers and most ads fail to
provide consumers with sufficient information to allow them to verify the advertisers‟
representations. Moreover, the Federal Trade Commission, in past law enforcement actions, has
evaluated the available scientific evidence for many of the ingredients expressly advertised as
clinically proven, and challenged the weight-loss efficacy claims for these ingredients.

          Natural/Safe Weight-loss Claims. Safety claims are also prevalent in weight-loss
advertising. Nearly half of all the ads in the sample (42%) contained specific claims that the
advertised products or services are safe and 71% of those ads also claimed that the products were “all
natural.”

         Safety claims can be difficult to evaluate, especially when so many ads fail to disclose the
active ingredients in the product. On the other hand, some advertisements disclose ingredients, e.g.,
ephedra alkaloids, that make unqualified safety claims misleading. Nevertheless, marketers in almost half
(48%) of the ads that identified ephedra as a product ingredient made safety claims. Only 30% of the ads
that identified ephedra as an ingredient included a specific health warning about its
potential adverse effects.

        Historical Comparison. To develop a perspective on how weight-loss advertising has
changed over time, this report also compares advertisements appearing in a sample of magazines
published in 2001 with ads in the same magazines in 1992. Compared to 1992, readers in 2001 saw
more diet ads, more often, and for more products. Specifically,

        C       The frequency of weight-loss advertisements in these magazines more than doubled,
                and

        C       The number of separate and distinct advertisements tripled.

Moreover, the type of weight-loss products and services advertised dramatically shifted from “meal
replacements” (57%), in 1992 to dietary supplements (66%), in 2001. Meal replacement products
typically facilitate the reduction of caloric intake by replacing high-calorie foods with lower-calorie

                                                    ix
substitutes, whereas dietary supplements are commonly marketed (55%) with claims that reducing
caloric intake or increasing physical activity is unnecessary.

         The considerable changes in the methods used to promote weight-loss products are the
most revealing indication of the downward spiral to deception in weight-loss advertising. The 2001
advertisements were much more likely than the 1992 ads to use dramatic consumer testimonials and
before-and-after photos, promise permanent weight loss, guarantee weight-loss success, claim that
weight loss can be achieved without diet or exercise, claim that results can be achieved quickly,
claim that the product is all natural, and make express or implied claims that the product is safe.
Finally, although both the 1992 and 2001 examples include unobjectionable representations, as well as
almost certainly false claims, the 2001 advertisements appear much more likely to make specific
performance promises that are misleading.

          Conclusion. The use of false or misleading claims in weight-loss advertising is rampant.
Nearly 40% of the ads in our sample made at least one representation that almost certainly is false
and 55% of the ads made at least one representation that is very likely to be false or, at the very
least, lacks adequate substantiation. The proliferation of such ads has proceeded in the face of, and
in spite of, an unprecedented level of FTC enforcement activity, including the filing of more than 80
cases during the last decade. The need for critical evaluation seems readily apparent. Government
agencies with oversight over weight-loss advertising must continually reassess the effectiveness of
enforcement and consumer and business education strategies. Trade associations and self-
regulatory groups must do a better job of educating their members about standards for truthful
advertising and enforcing those standards. The media must be encouraged to adopt meaningful
clearance standards that weed out facially deceptive or misleading weight-loss claims. The past
efforts of the FTC and the others to encourage the adoption of media screening standards have been
largely unsuccessful. Nevertheless, as this report demonstrates, the adoption and enforcement of
standards would reduce the amount of blatantly deceptive advertising disseminated to consumers
and efforts to encourage the adoption of such standards should continue. Finally, individual
consumers must become more knowledgeable about the importance of achieving and maintaining
healthy weight, more informed about how to shop for weight-loss products and services, and more
skeptical of ads promising quick-fixes.




                                                  x
I. An Overview

        A. A Never-Ending Quest for Easy Solutions

         Since at least 1900, American consumers have been searching for a safe and effective way to
lose weight. As a nation, it has been a losing battle. Overweight and obesity have reached
epidemic proportions.1 An estimated 61 percent of U.S. adults are overweight or obese, and the trend is
in the wrong direction.2 Overweight and obesity constitute the second leading cause of
preventable death, after smoking, resulting in an estimated 300,000 deaths per year at a cost (direct and
indirect) that exceeds $100 billion a year.3

         The struggle to shed unwanted pounds usually resolves itself into choosing between
responsible products or programs that offer methods for achieving moderate weight loss over time
and “miracle” products or services that promise fast and easy weight loss without sacrifice. Over
the course of the last century, popular weight-loss methods have included: prescription and over-
the-counter drugs and dietary supplements; surgical procedures such as gastro-intestinal bypass
surgery, gastroplasty (stomach stapling), and jaw wiring; the television shows of motivational weightloss
gurus; commercial weight-loss centers; commercial diet drinks; doctor-supervised very-low-
calorie diets, complete with their own vitamin shots, fiber cookies, and drinks; the development of
fat-free, low-fat, fake-fat, and sugar-free foods; weight-loss support groups; exercise trends such as
aerobics and body building; and cellulite creams.

         Almost all weight-loss experts agree that the key to long-term weight management lies in
permanent lifestyle changes that include, among other things, a nutritious diet at a moderate caloric level
and regular physical exercise. Nevertheless, advertisements for weight-loss products and services
saturate the marketplace, with many promising instantaneous success without the need to reduce caloric
intake or increase physical activity.

          This is not a new phenomenon. In the last 100 years, various types of weight loss products
and programs have gained and lost popularity, ranging from the ludicrous - diet bath powders,
soaps, and shoe inserts - to the dangerous, such as the fen/phen diet pill combination.4 Around the
1900s, popular weight-loss drugs included animal-derived thyroid, laxatives, and the poisons arsenic
and strychnine; eventually each was shown to cause weight loss only temporarily, and usually to be
unsafe to use. In the 1930s, doctors prescribed dinitrophenol, a synthetic insecticide and herbicide
that increases human metabolism so drastically that organs fail, causing blindness and other health
problems. The hormone human chorionic gonadotropin (HCG) became popular in the 1950s for
weight loss, and resurfaced recently, even though the FDA exposed it decades ago as effective only
to treat Fröhlich‟s Syndrome, a particular genetic imbalance occurring only in boys.5

       The 1990s saw an explosion in dietary supplement marketing, many of which are of
unproven value and/or have been linked to serious health risks.6 As discussed in this report, the

                                                     1
Federal Trade Commission has brought numerous cases against the advertisers of weight-loss
supplements for making false or misleading advertising claims. Other products may raise serious
safety concerns. For example, experts, including the American Medical Association, have raised
concerns about the safety of ephedra, a popular diet pill ingredient,7 and Health Canada recently
warned Canadian citizens against using ephedra for dieting because of its dangerous propensities.8

        B. The Role of Advertising for Weight-loss Products and Services

         As noted above, consumers may choose from a myriad of weight-loss products and
services. Consumers make their selections based, in part, on advertising. Advertising that presents false
or misleading information may distort consumer decision making. Even more troubling, if the entire field of
weight-loss advertising is subject to wide-spread deception, then advertising loses its important role in the
efficient allocation of resources in a free-market economy. If the purveyors of the “fast and easy fixes”
drive the marketplace, then others may feel compelled to follow suit or risk losing market share to the
hucksters who promise the impossible. Public health suffers as well. The deceptive promotion of quick
and easy weight-loss solutions potentially fuels unrealistic expectations on the part of consumers.
Consumers who believe that it is really possible to lose a pound a day
may quickly lose interest in losing a pound or less a week.

        C. Weight Loss: A Multi-Billion Dollar Industry

        More than two thirds of American adults are trying either to lose weight or to forestall
weight gain, according to a 1996 survey of 107,000 people by the Centers for Disease Control and
Prevention (“CDC”).9 The nearly 29 percent of men and 44 percent of women who are trying to
lose weight10 (an estimated 68 million American adults) comprise a huge potential market for sellers
of weight-loss products and services. No wonder overall sales in the weight-loss/weight-control
industry are burgeoning. According to an article in the Atlanta Business Chronicle, consumers
spent an estimated $34.7 billion in 2000 on weight-loss products and programs.11 This figure
includes sales of books, videos, and tapes, low-calorie foods and drinks, sugar substitutes, meal
replacements, prescription drugs, over-the-counter drugs, dietary supplements, medical treatments,
commercial weight-loss chains, and other products or services related to weight-loss or weight-
maintenance.

         Although total sales information is not available, the figures that are available are impressively
large. For example, year 2000 sales for the eight largest weight-loss chains totaled $788 million,
and sales for dietary supplements that purport to promote weight loss accounted for $279 million in
retail outlets alone.12 In a report from the Business Communications Company based on 1999
figures, total sales for weight-loss supplements were estimated at $4.6 billion.13 This corresponds
with estimates from the CDC, based on a five-state random-digit telephone survey, that 7% of the
adult population used one or more non-prescription weight-loss products during 1996 through
1998.14 The authors extrapolate from this survey that an estimated 17.2 million Americans used

                                                       2
nonprescription weight-loss products during this time period.15

         The amount of total sales for unproven or worthless products is not known, but it is
substantial. Infomercials, direct mail advertising, and free-standing inserts can generate tens of
millions of dollars in sales within a short period of time for a single product, and, as this report
demonstrates, there are hundreds, perhaps even thousands, of weight-loss products on the market. These
forms of saturation advertising do not require high response rates to be highly profitable. As an example
of the prevalence of hard-sell marketing for non-prescription weight-loss products,
spending on infomercials (usually 30-minute to an hour programs pitching products for direct sale via
telephone call-ins) for weight-loss and nutrition products exceeded $107 million in 1999.16 The alarming
increase in overweight and obesity combined with marketers‟ easy access to mass media outlets makes the
business of weight loss a booming enterprise.

II. Collection Methodology and Coding

         This report looks at weight-loss advertising disseminated through broadcast and cable
television, infomercials, radio, magazines, newspapers (including free-standing inserts in Sunday
newspapers), supermarket tabloids, direct mail, commercial e-mail (spam), and Internet websites.
We collected a total of 300 advertisements from a variety of sources. Except as noted with regard
to Internet sites, we did not attempt to select a scientifically random sample.17 At the same time, no
effort was made to collect just “bad” ads. In general, these advertisements appeared between
February and May 2001.

       Television and radio advertisements: Members of the Partnership for Healthy Weight
Management18 (the Partnership) monitored television and radio advertisements and sent identifying
information to the FTC staff, who ordered copies of the ads from Video Monitoring Service.
Twenty radio and television ads were included in our sample.

         Infomercials: The FTC staff obtained a list of twenty-eight infomercials appearing between
January 1, 2001 and May 7, 2001 from Infomercial Monitoring Service, Inc. and ordered six
infomercials, based on the product description and the date the infomercial initially aired. We gave
preference to infomercials that appeared to involve relatively new products and excluded
infomercials marketing exercise equipment and electronic devices. When there were two
infomercials for the same product, we selected the infomercial with the most recent initial
appearance date.19

       Magazines and supermarket tabloids: The FTC staff selected the following magazines and
supermarket tabloids for monitoring: Cosmopolitan, Family Circle, Fitness, First for women,
Glamour, Globe, Ladies Home Journal, Let’s Live, Marie Claire, McCalls, National Enquirer,
National Examiner, Redbook, Rosie, Self, Soap Opera Digest, Star, Sun, Weekly World News,
Woman’s Day, Women’s Fitness, and Women’s Own. We selected some of the publications

                                                    3
because of their past history of running questionable weight loss advertisements. With regard to
magazines published on a monthly basis, we reviewed each issue from February through May for
weight-loss advertisements. We reviewed only selected editions of weekly publications.

          Newspapers: The FTC staff obtained a sample of U.S. newspaper advertisements from
Burrelle‟s Information Services, a newspaper clipping service. The ads appeared during April and
the first week of May 2001. We included newspaper ads in our sample if they contained references
to specific amounts of weight loss, e.g., lose 30 pounds by summer, or John Doe lost 30 pounds.

        Direct Mail and Unsolicited Commercial e-mail (spam): We collected direct mail and spam ads
from the FTC staff, members of the Partnership, and consumers.

        Internet Ads: The Partnership and two Northern Illinois University researchers organized a
"surf day" project to identify relevant websites. In December 2000, a student-team collected data,
using 14 popular search engines and 139 keyword search terms, about Internet websites containing
weight-loss related information.20 Through this process, participants located thousands of Internet
websites. Researchers compiled URL and other information about the websites in a database. The
FTC staff randomly selected every 50th still-active site in the database until it had accumulated a
representative sample of 44 commercial sites that promoted weight-loss products and/or services.

         The FTC staff collected and coded the following information from each advertisement:
company name; product name; product type, e.g., meal replacement; publication and publication dates;
method of dissemination (broadcast TV, cable TV, infomercial, radio, magazine, newspaper, tabloid,
direct mail, free standing insert, unsolicited commercial e-mail (spam), and Internet website); and purchase
options (retail outlet, website, direct mail, telephone, other).

         The FTC staff also coded the use of the following specific types of claims or advertising
techniques: consumer testimonials; before-and-after photos; rapid weight-loss claims; lose weight
without diet or exercise claims; long-term or permanent weight-loss claims; representations that the
user will not fail no matter how many times he or she has failed before; clinically or scientifically
proven claims; endorsements by medical professionals; money-back guarantees; and all-natural
and/or safe claims. The FTC staff also recorded the specific text of the headline and representative
claims for analysis.

         We collected additional information from ads using consumer testimonials, including: the
number of testimonials used; the high and low range of weight loss claimed, e.g., 10 lbs. in two
weeks/30 lbs. in 30 days; whether there was a disclaimer associated with the use of the testimonials, what
the disclaimer said, and whether the disclaimer was conspicuous.

        With regard to safety, we collected information on whether potential side effects were
disclosed. Where there was a safety warning, we recorded the text of the warning. The FTC staff

                                                     4
collected information concerning the active ingredients in the product if the advertisement provided that
information.


III. Analysis of Weight-loss Advertisements

        A. General Observations

          An ad for a product made from ground-up shells of shrimps, crabs, and lobsters claims,
“Scientists dedicated years of research to come up with a high powered diet ingredient with no side
effects” and asks, “Have you ever seen an overweight fish? Or an oyster with a few pounds too
many? Everyone knows that sea animals never get fat.” A testimonial in this ad alludes to the
product‟s ability to select only unwanted fat deposits: “The best thing about [the product] is that my waist
size is 3 inches smaller, now only 26 inches. And it has taken off quite some inches from my butts [sic] (5
inches) and thighs (4 inches), my hips now measure only 35 inches. I still wear the
same bra size though. The fat has disappeared from exactly the right places.” In fact, there is no
convincing evidence that the shells of shrimps, crabs, or lobsters cause weight loss or that weight
loss can be selectively targeted to specific parts of the body.

          An ad for a second product whose active ingredient is apple pectin is headlined, “LOSE UP TO 2
POUNDS DAILY... WITHOUT DIET OR EXERCISE! I LOST 44 POUNDS IN 30
DAYS!” The ad further claims that “Apple pectin is an energized enzyme that can ingest up to 900 times
its own weight in fat. That's why it's a fantastic fat blocker.” The ad claims that the product can “eliminate
fat for effortless weight loss” and that it produces the “same results as jogging 10 miles per week, an hour of
aerobics per day, 15 hours of cycling or swimming per week.” In fact, there is no known pill that will
cause up to two pounds of weight loss daily (with or without diet and exercise), and the claim of 44 pounds of
weight loss in 30 days is not credible.

        In an infomercial for yet another weight-loss product, a beaming spokesperson and a
purported scientific expert standing in front of a colorful pastry display assure viewers that to lose
weight while using the product, “you don‟t really need any willpower. You don‟t have to diet or
deprive yourself of foods in any way.” As the endorsers make these claims, the words “Call Now”
and “Risk Free,” with the telephone number to order, appear in large, yellow text on one part of the
screen on a blue background. At the same time, dim and indistinct white letters on a moving,
mottled background advise, “A healthy diet and exercise are required to lose weight.”

        The world of weight-loss advertising is a virtual fantasy land where pounds “melt away”
while “you continue to eat your favorite foods”; “amazing pills . . . seek and destroy enemy fat”;
researchers at a German university discover the “amazing weight loss properties” of asparagus; and
the weight-loss efficacy of another product is comparable to “running a 20 mile marathon while you
sleep.” It‟s a world where, in spite of prevailing scientific opinion, no sacrifice is required to lose

                                                     5
weight (“You don‟t change your eating habits and still lose weight”). Quick results are the
(promised) norm ("The diet works three times faster than FASTING itself!"). You can learn how to
lose weight with "No exercise. No drugs. No pills. And eat as much as you want - the more you
eat, the more you lose." There is no need to worry because the products are “safe,” “risk free,”
and/or “natural,” and some marketers are so concerned for your safety that they warn you to cut
back if you lose too much weight (“If you begin to lose weight too quickly, take a few days off!!!”).
You can always get your money back because so many of these “amazing” products are
“guaranteed” (“. . .we‟ll give you your money back. Straight away. No questions asked”).

          And for those who remain skeptical, there is an answer. The products are backed by
“clinical studies” or are “clinically tested” (“Clinical and laboratory tests at leading universities and
hospitals, have proven that this product is effective”). Even if they do not purport to be clinically
proven, many claim to be the product of years of scientific research (“Scientists dedicated years of
research to come up with a high powered diet ingredient with no side effects”) or are “doctor
recommended.”

          Moreover, according to many of the ads, you can “stay slim forever” because the weight
loss is “permanent” (“I can still eat whatever I want without any danger of gaining the weight
back.”). Finally, you can say good-bye to the                Table 1: Number of Ads by Media Type
failure syndrome because no matter how many
times you‟ve tried to lose weight in the past, the              Medium                     Number of Ads
product will give you the “secret to lasting weight loss
                                                                Newspaper/FSI                    85
success.”
                                                              Magazine                          68
        B. Media and Product Types                            Tabloids                          19

         Three hundred advertisements for 218                 Internet                          44
different products or services were collected and             Commercial email                  41
reviewed. A list of the products is included in
                                                              Direct Mail                       27
Appendix A. Table 1 identifies the number of ads for
each type of medium.21                                        Radio                             13

                                                              Broadcast                          7
         The advertisements covered virtually every
kind of product or service imaginable. Categories         Infomercial                       5

with 10 or more advertisements included: dietary
supplements (157), meal replacements (e.g., diet
shakes) (33), hypnosis (27), food (15), diet
plans/programs/diet centers (21), transdermal products (patches and creams) (11), and wraps (10).
Some ads promoted multiple products, and in some instances, it was not possible to determine the
product category based solely on the advertisement. Only about half (49%) of the advertisements
for dietary supplement or transdermal products disclosed the product‟s active ingredients in the

                                                      6
advertisement. Of those that identified ingredients, the most common were ephedra, chitosan, and
chromium.22

       C. Claims by Category

         A clear pattern of claims and techniques emerged from our analysis. Nearly all of the ads
reviewed used at least one and sometimes several of these techniques. Figure 1 shows the
frequency of common advertising claims and techniques and what percentage of the 300 ads used the
claim or technique. A composite ad showing the frequency of each claim or technique appears on page 8
of this report. Table 2 shows the percentage of ads by product category that contains the claims. The
following sections discuss specific claims and techniques in detail.



      Figure 1: Prevalence of Claims - All Media




                                                   7
Depici
                      (in percentages) of what the FTC f
                      trends in the language us"1
                      weightloss ads.




                   42%

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                                                                                   in a major university-based study in
                                                                                                   Gotoberg. Sweden.
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Table 2: Frequency of Claims by Product Category
                Dietary         Hypnosis     Meal           Food       Plans/     Wraps      Trans-     Other
                Supplement                   Replace-                  Programs              dermal
                s                            ment                      /                     Products
                                                                       Diet
                                    (27)         (33)           (15)   Centers        (10)     (11)         (24)
                    (157)                                                 (21)

 Testimonial    59%             96%          70%            80%        76%        50%        45%        63%
 s

 Fast Results   60%             59%          58%            33%        43%        90%        73%        42%

 Guaranteed     59%             93%          36%            7%         24%        60%        55%        42%
 results

 Natural        56%             11%          42%            47%        14%        50%        27%        33%

 No Diet or     55%             56%          12%            20%        14%        20%        27%        33%
 Exercise

 Long-          38%             100%         18%            27%        33%        60%        18%        50%
 Term/Perma
 nent

 Safe/No        55%             30%          27%            20%        24%        50%        36%        25%
 Side Effects

 Before-and-    33%             85%          36%            60%        76%        40%        36%        25%
 After

 Clinically     53%             0            36%            7%         10%        40%        82%        33%
 Proven

 No More        32%             89%          27%            20%        24%        20%        9%         38%
 Failure

 Medical        34%             7%           12%            7%         10%        0          36%        38%
 Approval

 Excessive      12%             4%           0              0          5%         0          9%         0
 Wt. Loss
 Warning




                 1. Consumer Testimonials

        Consumer testimonials are pervasive in weight-loss advertising. Of the advertisements in the
sample, 195 (65%) used consumer testimonials as a mechanism to promote the weight-loss product
or service. The ads that used this technique contained about five testimonials on average, with some
containing as many as 50 or more. Testimonials were most often used in ads promoting hypnosis.




                                                        9
Testimonials rarely described modest or realistic successes, instead touting extraordinary
and rapid weight loss. Nearly 90% of ads using consumer testimonials claimed specific amounts of
weight loss and more than half (56%) included a specific time period for the largest amount of
weight loss reported in the ad, e.g., “I lost 30 pounds in 30 days.” The average for the largest
amount of weight loss reported in each of the 195 advertisements was about 71 pounds. Fifty-
seven (57) ads (30%) reported weight loss exceeding 70 pounds, and 38 ads (20%) reported
weight loss exceeding 100 pounds.

         In many instances ads used testimonials reporting weight loss in ranges that are, in all
likelihood, simply not achievable for the products being promoted. Thirty-six ads used 71 different
testimonials claiming weight loss of nearly a pound a day for time periods of 13 days or more.
These ranged from claims of 22 pounds in 13 days to 120 pounds in seven weeks. All but three of these
ads were for dietary supplement products.

        There are many examples of implausible testimonials but perhaps the most remarkable is this one
from a woman who claimed:

        7 weeks ago I weighed 268 lbs, now I am down to just 148 lbs! During this time I didn‟t
        change my eating habits at all: the pounds must have disappeared only due to the new
        slimming capsule. My appearance is so different that my friends actually believe that I had
        liposuction.

          The product featured in this advertisement claims to work by preventing the absorption of
fat in the digestive system. In fact, weight loss of this magnitude would require a net calorie deficit of 8,571
calories per day over the course of seven weeks. Even complete fasting would not produce this kind of
result. Nevertheless, this testimonial was disseminated to millions of Americans through Cosmopolitan, Soap
Opera Digest, National Enquirer, Women’s Day, Let’s Live, Women’s Own, McCall’s, Star, and
First for women.

        Testimonials in weight-loss advertisements appear to serve at least two functions. First, they
convey an efficacy claim, i.e., the product works; and second, they attempt to minimize consumer
skepticism. Many potential purchasers of weight-loss products have purchased other weight-loss
products that failed. The challenge for the advertiser is to convince the purchaser that its product will work
when all the others have not. One way to do that is to present the purchaser with
examples of “real people” just like themselves who have used the product successfully. Indeed, in some
instances, particularly infomercials, the endorser directly addresses viewers to reassure them that the
product really worked when all other products and programs failed.

         Weight-loss testimonials convey more than a limited message about one person‟s
experience. They also convey a very convincing claim to consumers that the product is effective
and, in some instances, that the product will enable the user to experience similarly dramatic results.
Thus, testimonials can be deceptive in at least three distinct ways. First, the testimonialist may not
have experienced the reported result. Testimonials that claim that users lost more than 30 pounds in

                                                     10
as little as 30 days likely fall into this category. Second, the reported weight loss may not be
attributable to the product, but to other diet, exercise, or lifestyle changes. Third, an advertisement
presenting testimonials claiming extreme and atypical weight loss as typical or ordinary experiences
is likely to be deceptive without an indication of the more modest weight loss results that the typical
user would experience using the product.23                  Table 3: Sample disclaimers used in weight-
                                                        loss advertisements.
         Typicality Disclaimers: The most common         Results not typical and depends on diet
way to address this last issue is through                and training program.
disclaimers. Seventy (70) of the 195 ads (36%)
had some form of disclaimer addressing the issue of      Results not typical.
whether the reported results are meant to be             Results may not be typical.
representative of users of the product or service. In
only 18 of the cases, however, was the                   Results may vary.
disclaimer conspicuous or proximate to the
                                                         Individual results vary and can be more or
testimonials. In the vast majority of
                                                         less than the results mentioned.
advertisements, disclaimers were buried in fine
print footnotes or, in video ads, flashed as a video     Results Atypical.
superscript too quickly for viewers to read. Table
                                                         These results are not typical of every
3 provides a sample of disclaimers found in the
                                                         client. As individuals vary, so do results.
selected advertisements.
                                                         Your results may vary.
          Some of these disclaimers do little to
                                                         Benefits vary from each person.
inform consumers that the results reported in the
advertisements are, at best, extreme cases, and          Results obtained with this program can and do
that consumers should not expect to achieve              vary.
similar results. For example, a disclaimer telling
                                                         Yes! These are actual comments from our
consumers that “results may vary” tells consumers
                                                         customers - girls just like you telling us
almost nothing other than that everyone will not         about the exceptional, non-typical results
achieve 50 pounds of weight loss. With one or            they got with our amazing weight loss
two notable exceptions, advertisers made no effort to    system.
provide specific information about the actual
weight loss the average consumer could expect
using a particular product.

                2. Before/After Photos

         Before-and-after photos, often appearing with
testimonials, are commonly used in weight loss ads. Forty-
two percent (42%) of the ads in this sample contained
before-and-after pictures. More than just graphic consumer
testimonials, these pictures try to create an image of what the
consumers could accomplish personally if they only used the advertised product. Before-and-after
pictures usually fall into one of two categories: (1) the illustrated personal testimonial, and (2) the

                                                  11
clinical comparison of isolated body portions.24 The former type often contains the following
elements:

Before Picture: Snapshot quality photograph of the subject that incorporates poor posture, neutral facial
expression, unkempt hair, unfashionable attire, poor lighting, and washed out skin tones.

After Picture: Brightly lit (sometimes studio portrait quality) pose of smiling subject in fashionable, often
skimpy, attire, shoulders held back, tummy tucked in, with a
stylish hair style and carefully applied makeup.

Eighty-eight percent (88%) of the ads with before-and-after
pictures contained illustrated testimonials. In television spots and
infomercials, this type of before-and-after treatment often
incorporates a before photograph superimposed over a
videotaped segment featuring the subject after using the advertised
product or service making his/her videotaped testimonial.

         Another form of before-and-after illustration isolates one
portion of a subject's anatomy, usually the waist or buttocks, to
show purported results, sometimes in a progression of three or
more photographs over a period of time. These pictures often emulate the kind of illustrations found in
medical articles. A few ads (two in this sample) feature
both types of before-and-after pictures. Eleven percent
(11%) of the ads with before- and-after pictures featured
“clinical” comparison pictures.

                            Often the only discernable
                   difference in the before picture and the
                   after picture is a change in posture and
                   body control. In the before picture the
                   subject's shoulders are slumped, the
                   abdominal muscles are relaxed, and the pelvis thrust forward to emphasize body fat.
                   The after picture shows the subject holding in his/her abdomen and/or holding back
                   his/her shoulders to emphasize lean body mass. A close examination of the before
                   picture in this type of ad raises the question of whether the subject needed to lose
                   weight and suggests that little or no weight was actually lost.




                                                     12
Some before-and-after
photographs clearly appear to have been
altered, usually by placing an image of the
after subject‟s head on the photographic
image of another (very obese) subject‟s
body. Finally, it is not always clear
whether “clinical” before-and-after
pictures are depicting the results from
actual users of the advertised product or
service or are intended merely to be
illustrative of the product‟s or service's
capacity to produce weight loss.




                 3. Rapid Weight-loss Claims

          Fifty-seven percent (57%) of the
ads in our sample promised rapid weight       Table 4: Representative Claims That Promise Fast Results
loss, often claiming that excess weight or     “This combination of plant extracts constitutes a weight-loss
fat can disappear in a matter of days or       plan that facilitates what is probably the fastest weight loss ever
weeks. Claims in this category range           observed from an entirely natural treatment.” (elixir
                                               purportedly containing 16 plant extracts)
from explicit promises of rapid weight
loss (“A Quick Weight Loss Plan For            “Just fast and easy, effective weight loss!” (fucus vesiculosus)
People In A Hurry” “RAPID WEIGHT
LOSS IN 28 DAYS!” “Clinically                  “Lose 10 lbs. in 8 Days!” (apple cider vinegar)

proven to help you lose weight . . . fast”)    “Rapid weight loss in 28 days!” (ephedra)
through claims for immediate or near
immediate results (“Starts to work within      “Knock off your unwanted weight and fat deposits at warp
minutes” “Works in one minute” “You only       speeds! You can lose 18 pounds in one week!” (ingredients not
                                               disclosed)
have to stay on it 2 DAYS TO SEE
RESULTS”) to promises of amounts of            “Clinically proven to cause rapid loss of excess body fat.”
weight loss over time periods that             (phosphosterine)
compute to rapid rates of weight loss.
                                               “Two clinically proven fat burning formulations that are
(“YOU CAN LOSE 18 POUNDS IN
                                               guaranteed to get you there fast or it costs you absolutely
ONE WEEK!” “lose up to 10 lbs in 48            nothing.” (ingredients not disclosed)
hours”). Additional examples are set

                                                   13
forth in Table 4. Even the product names (“Redu-Quick, “Slim Down Fast”) emphasize speedy
results.

         Such results are not only unlikely, they would be accomplished at an increased risk to health.
Rapid weight loss has been associated with an increased risk of developing gallstones.25
Consequently, responsible programs that offer proven means of rapid weight loss for obese patients with
such diseases as coronary artery disease or Type II diabetes provide physician supervision
while patients are actively losing weight.

         Rapid weight-loss claims often appeared in combination with the promise of easy weight loss
(“Lose those pounds the quick and easy way,” “Lose weight while you sleep,” “Lose weight quickly
and easily and keep it off”) without the need for diet or exercise. In 54% of the ads promising rapid
weight loss, there are also claims for easy weight loss or weight loss without the need for changing diets or
increasing exercise levels.

                 4.       Lose Weight Without Diet or Exercise

            Despite the well-accepted prescription of diet and exercise for successful weight
management,26 42% of all of the ads reviewed promote a dizzying array of quick-fix pills, patches,
potions, and programs for effortless weight loss. An ad for an apple cider vinegar pill, for example,
boasts that “you can eat as much as you want and still lose weight,” because “when properly
distributed, an intake of           Table 5: Lose Weight Without Diet or Exercise Claims
4,000 calories a day can
actually help you lose weight        “awesome attack on bulging fatty deposits . . . has virtually eliminated the
                                     need to diet.” (Konjac root pill)
instead of gain it.” Another ad
exclaims that a pill                 “They said it was impossible, but tests prove [that] my astounding
purportedly containing the           diet-free discovery melts away...5, 6, even 7 pounds of fat a day.”
“herbal equivalents” of              (ingredients not disclosed)

ephedrine, caffeine, and             “The most powerful diet pill ever discovered! No diet or workout required.
aspirin, plus other ingredients,     The secret weight-loss pill behind Fitness models, Show Biz and
is “scientifically shown in a        Entertainment professionals! No prescription required to order.”
recent clinical study to elicit a    (ingredients not disclosed)
613% greater rate of fat loss
in non-exercising subjects as         “lose up to 30 lbs . . . No impossible exercise! No missed meals! No
                                     boring foods or small portions!” (plant extract fucus vesiculosus)
compared to subjects not
using it.”27        Additional         “lose up to 8 to 10 pounds per week . . . [n]o dieting, no strenuous
examples are set forth in            exercise.” (elixir purportedly containing 16 plant extracts)
Table 5.28
                                       “my 52 lbs of unwanted fat relaxed away without dieting or grueling
                                      exercise.” (hypnosis seminar)
          In addition, 64% of
the ads containing the                “no exercise...[a]nd eat as much as you want - the more you eat, the more
effortless weight-loss claims         you lose, we‟ll show you how.” (meal replacement)
outlined above also promise

                                                       14
that the advertised products and services will produce fast results. These ads include such claims as
“[t]ake off up to 10 pounds and 6" in just 2 days...[n]o exercise,” “lose 3-4 pounds a week without
dieting or exercise,” “[I]‟ve lost 68 lbs in 4 months...does not require restricted diets or exercise,” and “[I]
ate more and exercised less and still lost 44 lbs.”

                 5. Lose Weight Permanently

         “You lose it. You gain it back. Use [the advertised product] with every diet program and
keep it off.” Many consumers have lost weight only to gain it back again. In fact, studies indicate
that most people who lose weight gain it back within five years.29 Consequently, “take it off and
keep it off” claims are fairly common in weight-loss advertising. In spite of the blue-sky promises of
many marketers (“Get weight off and keep it off,” “You won't gain the weight back afterwards,
because your weight will have reached its equilibrium,” “Discover the secret to permanent weight
loss”), experts have repeatedly observed that although persons generally lose weight while actively
participating in a weight loss regimen treatment, they tend to regain the weight over time once
treatment ends.30 According to the National Academy of Science Food and Nutrition Board,
“Many programs and services exist to help individuals achieve weight control. But the limited
studies paint a grim picture: those who complete weight-loss programs lose approximately 10
percent of their body weight only to regain two-thirds of it back within 1 year and almost all of it
back within 5 years.”31

          For persons who have lost weight in the Table 6: Long-term Weight Maintenance           Claims and
past only to gain it all back again, the appeal         Other Related Claims
of a “once and forever” weight-loss product
can be strong, especially when combined with               Percentage of ads with long-term        41%
references to the syndrome of failure many                 maintenance claims
dieters experience or the promise of                       Percentage of ads combining long-
effortless, no-sacrifice weight-loss success.              term maintenance claims with no diet    26%
(Table 6) According to almost all weight-loss              or exercise claims
experts, if there is a key to long-term                    Percentage of ads combining long-
maintenance success, it requires permanent                 term maintenance claims with            23%
lifestyle changes on the part of the dieter:               references to past failures
nutritional eating at moderate caloric levels, a regular Percentage combining all three            15%
physical fitness routine, and
abandonment of old habits that may have
contributed to weight gain.32

         The publicly available scientific research contains very little evidence that would substantiate
long-term or permanent weight-loss claims for most of today‟s popular diet products. Experts
usually insist on studies going out at least one year, if not two, in order to substantiate a claim for
long-term weight-loss maintenance.33 Reliable studies of the long-term effectiveness of weight-loss
products and programs are difficult and expensive to conduct. Not many marketers are likely to
want to spend the money and the time necessary to have such tests of their product‟s effectiveness

                                                      15
done. But that does not prevent many of them from assuring consumers that their product or service is
“the secret to permanent weight loss” or that “you may never need to diet again.”

                  6. No Matter How Many Times You Failed Before

         Among the weight-loss product advertisements surveyed, many contain “no more failure
claims” that, although this may not be the first product tried, it will be the last. (Table 7) One
marketer asks, for example: “Are you tired of fad diets that never seem to work? Are you
frustrated when you gain back most or all of Table 7: No More Failure Claims
the weight you lose? Are you fed up with
throwing money down the drain on diets that              Percentage of ads with no more failure
don‟t work?” This marketer, of course,                   claims                                    34%
claims to offer the one product that will finally        Percentage of ads with no more failure
work.                                                    claims and long term/permanent claims     23%

                                                        Percentage of ads with no more failure
         Many advertisers take an empathetic            claims and testimonials                  29%
and understanding tone, assuring consumers
that they are not to blame for their failure to lose
weight:

         Dear Friend: If you‟ve ever tried losing weight using one of the hundred diets
         programs available, you know how difficult and frustrating it can be. And you are not
         alone. Most people who sincerely - even desperately - want to lose weight have never
         been successful on a diet. That‟s because diets do not work.

         Others take advantage of the difficulty many consumers have in maintaining lost weight:

         You‟ve been there. You want to lose weight, and you‟ve been successful before.
         But after a while, you‟re right back where you started - and the pounds always seem to
         come back . . . [The advertised product] can help you break the cycle.

        This advertising technique frequently takes the form of a testimonial from a product user who
confides that he or she has experienced the same weight-loss frustrations:

         Discouraged, I started trying all the tricks, appetite suppressants, creams, diets and
         medications. Fads came and went and I had spent a fortune with no result.
         Of course, I tried to lose weight numerous times. But each new diet left me starved and
         deprived. I‟d lose weight, but end up irritable and unhappy. Diets weakened me
         physically and emotionally. I once lost all my weight on a liquid fast. It was incredibly
         expensive. Of course, the weight came right back on.

      As a result of extravagant advertising claims such as the ones described in this report,
consumers may develop unrealistic notions about how much weight they can lose or keep off.

                                                       16
Consumers purchase products purporting to be “unique” or “revolutionary” in their effectiveness and
experience failure after failure.

                 7. Scientifically Proven/Doctor Endorsed

          Many marketers attempt to bolster the credibility of their claims by asserting that the
advertised product has been scientifically tested and proven to work. (Table 8) Phrases like “the
clinically proven healthy way to lose weight,” “clinically tested,” “scientifically proven,” and “studies confirm”
bestow products with an aura of scientific legitimacy and aim to persuade consumers that they should feel
confident that a product will
                                                     Table 8: Clinically Proven, Medically Approved Claims
work.

          Several advertisements describe the      Percentage of all ads with clinically
dramatic results obtained in clinical studies.     proven claims                         40%
One advertisement, for example, asserts that       Percentage of ads with medical
“Clinical studies show people lost 300%            approval claims                       25%
more weight even without dieting.”34 Many
                                                   Percentage of ads with both
advertisements also tout the fact that             clinically proven and medical
products were either developed or tested at        approval claims                       17%
well-known, respected, and “independent”
institutions, such as “major universities,” “a
leading U.S. medical center,” or “leading
hospital[s].” Other advertisements showcase the impressive credentials of the researchers
conducting the studies supporting the product, such as an advertisement that claims that a study
proving the efficacy of the product was conducted by “the country‟s most respected scientists.”

         Many advertisers also imply that there is a substantial body of competently conducted
scientific research supporting the efficacy of the product.35 For instance, one advertisement claims that
the efficacy of a product is “[b]acked by volumes of independent research and hundreds of published
studies by the most prominent universities and medical journals in the world.” Another marketer claims
that "[s]cientists dedicated years of research to come up with a high powered diet ingredient [contained
in the product] with no side effects.”

         Although some advertisements briefly describe the results, and provide some information
about the methodology, of a particular study, such as the study‟s duration and number of
participating subjects, most of the advertisements fail to give consumers sufficient detail about a
study to allow consumers to verify the advertiser‟s representations. Moreover, 20 of the 117 ads
making “clinically proven” claims were for products that contained ingredients already evaluated by
the Federal Trade Commission in the context of past law enforcement actions challenging specific
weight loss claims. These ingredients, which include fucus vesiculosus, chromium, L-carnitine,
chitosan, psyllium, 7-keto-DHEA, hydroxycitric acid, seaweed, konjac root, garcinia cambogia and
glucomannan, were challenged based on insufficient scientific evidence to support the weight loss
claims made in the advertisements.

                                                      17
Still another technique that advertisers use to convince consumers that they are buying a
tested and proven product is to assure consumers that a product is “recommended,” “approved by,”
and often “developed” or “discovered” by a medical professional. (Table 8) For example, several
advertisements prominently feature a “physician” wearing a white lab coat and a stethoscope and
sitting in front of a diploma-filled wall. To add an air of legitimacy to the advertised product, some
advertisements appear to be written by a physician. Others feature interviews with doctors or
researchers who tout the product as being safe and effective. One Internet site even invites
customers to call a “Medical Advisory Board” staffed with “qualified medical professionals” to
answer medical questions.

          Expert endorsements, however, can be misleading. For example, an advertisement may fail
to disclose that the medical professional endorsing the product has a financial interest in promoting
the sale of the product - a fact likely to affect the weight consumers give the endorsement and that
could affect their purchase decision.36 Marketers may even use a fictitious medical professional to
endorse their products.37 In other instances, experts either may not have actually reviewed the
scientific evidence on the product or its ingredients or failed to utilize existing expert standards in
conducting their review.38

                8. Money-back Guarantees

        The analysis revealed that money-back guarantees are one of the most frequently used
techniques in weight-loss advertising. Fifty-two percent (52%) of all the ads reviewed include this
representation. (Table 9) One advertiser, for Table 9: Money-back Guarantees
example, encourages consumers to pay the
price of the product only if the product has         Percentage of ads that promise
helped the consumer slim down: “If not, send         guaranteed results                    52%
it back and pay nothing. There will be no
                                                     Percentage of ads that have both
questions asked and you won‟t owe us a               guaranteed results and no more
dime.” Another advertiser advises                    failure claims                        24%
consumers that the company would not
guarantee its products if they did not work as
advertised: “Believe me, I am not a gambler.
I would never provide such an opportunity if I wasn‟t totally convinced that this is the weight-loss
breakthrough of the decade, and there‟s no need to worry about too many requests for refunds.”

         Although many companies guarantee “consumer satisfaction” in general, several
advertisements make very specific guarantees: “Whether you diet or not, [the marketer] guarantees that
you‟ll lose up to seven pounds in the first week and then one dress or pant size every two
weeks thereafter, or pay nothing.” Another marketer promises consumers that, “no matter how many
times you‟ve tried before . . . no matter how much weight you have to lose . . . no matter how sluggish
your metabolism . . . you will lose up to 10 to 15 pounds in just one week . . . up to 35 pounds in 3 weeks.
Yes. Guaranteed! You lose or it doesn‟t cost you a penny.”


                                                   18
For any number of reasons, marketers may fail to honor refund requests at all or delay
honoring them for months. In fact, the Federal Trade Commission has brought several cases against
marketers failing to make refunds promised in their advertising.39

                 9. Safe/All Natural Claims

         Safety claims are a prevalent marketing technique in weight-loss advertising. Nearly half of
all the ads in the sample (42%) contained specific claims that the advertised products or services are
safe. These claims are made in a variety of ways. Some ads contain direct, unqualified
representations about the safety of the product or service in producing weight loss, including such
statements as “safe and effective,” “100% safe and natural,” “safe and gentle as a vitamin pill,” “safe,
immediate weight loss,” and “safely lose up to 6 lbs of fat, fluid, and flesh in just the first 24 hours
alone.” Others make direct comparisons between the safety of the product or service and other
weight-loss methods, with claims like “safer than liposuction,” “safest and most effective strategy [for
weight loss],” and “safest weight management system in the world.” Finally, some safety claims are
combined with compelling assertions of scientific proof of safety. Examples of those claims include
such statements as “proven safe and effective,” “proven 100% safe,” and “tested for years and
found to be very safe.”

         Many other weight-loss advertisements strongly imply that the product or service is safe
because it has no side effects, is not a prescription weight-loss drug, or contains no potentially
harmful stimulants. These representations include claims like “no side effects,” “no dangerous pills or
tablets to take,” “[pills] do not pose a health hazard,” “88% success rate with virtually no side
effects,” “in no way can [product X] harm your health,” “no dangerous dehydration nor depression,”
“contains no stimulants that can harm the heart, increase blood pressure...,” “skip risking your health
[from prescription drugs],” and “none of the harmful side effects often associated with prescription
diet products.” One ad claimed that “the active compound has been recognized by the FDA as safe
and effective for weight loss.”

         Claims of “all natural” often appear in conjunction with safety claims. Almost three quarters
(71%) of those ads containing safety claims also had “natural” claims. These two claims appeared in
30% of all the ads that we reviewed, often in the same sentence. Examples of combined claims
include “100% natural with no side effects,” “all natural 100% safe,” “lose weight naturally, safely,”
“100% natural so it‟s totally safe,” and “lose weight in an easy way that is natural and that won‟t hurt
your body.” Overall, 44% of the ads that we reviewed. made some version of the “all natural”
claim.

        Safety claims sometimes appeared in ads promoting the product in a way that could create the
potential for injury. For example, 73% of the ads in our sample that contained safety claims also
represented that the product or service would produce “fast,” “quick,” or “immediate” results. If the
product actually worked as quickly as advertised, it could produce potentially dangerous results, because
rapid weight loss and safety are antagonistic goals. In fact, rapid weight loss, if not closely monitored by a
physician, can result in serious adverse health consequences.40

                                                    19
Finally, of those weight-loss advertisements that contained safety claims, 27% also included some
type of safety-related warning in the advertisements. These warnings varied widely in
substance and detail. Some stated simply that you should “consult your doctor,” or “consult your
physician before beginning this or any weight-loss or exercise program.” Others included more
targeted warnings, such as “do not use this product if you have high blood pressure, are pregnant or
breast feeding, or on medication for a heart condition.” Often, the safety warning is presented in a manner
that viewers are likely not to notice it.

         One ad contained a warning about serious health effects: “[t]his product has ephedrine
group alkaloids in the form of herbal extracts and may cause serious adverse health effects.” This ad also
included the claim that the product was “shown to be safe by two independent laboratories.” Conflicting
messages in an advertisement about safety may confuse consumers and, ultimately, may cause them to ignore
safety-related warnings.

         Safety claims for weight-loss products are of serious concern. The primary concern is that
potentially serious adverse health effects can result if the claim is untrue or the effects of a product
are unproven. This concern is particularly important where the product may present special
undisclosed risks for certain populations, such as pregnant women or nursing mothers, or where the
long-term health effects are unknown. In addition, certain products or ingredients may interact
adversely with other medications that consumers might be taking, or may exacerbate pre-existing
health conditions faced by overweight and obese consumers, including, for example, heart disease,
high blood pressure, and diabetes. Ephedra or ephedrine alkaloids, for example, may be associated
with dangerous effects on the central nervous system and heart and may result in serious injury for
some persons.41

        Almost half (48%) of the ads that identified ephedra as a product ingredient made safety
claims, yet only slightly more than half of those (55%) included a specific warning about the health
risks of ephedra. Only 30% of all ads that identified ephedra as an ingredient included a specific
health warning about its potential adverse effects. Even more disturbing from a safety perspective,
fully 60% of ads that made safety claims did not identify ingredients at all. Consumers‟ inability to
make informed decisions about the safety of such products clearly raises the potential for serious
adverse health consequences.




                                                   20
IV. Historical Comparison: 1992/2001

          To develop a perspective on how weight-loss advertising has changed over time, we
compared advertisements appearing in a sample of magazines published in February thru May 2001
with ads that appeared in the same magazines in February thru May 1992. The magazines selected
were Family Circle, Cosmopolitan, Women’s Day, Glamour, McCall’s, Ladies Home Journal,
Self, and Redbook.42 These magazines were selected because they have been in publication for
more than 10 years and have a history of running weight-loss ads. With the exception of Self, each
of these magazines has run one or more weight-loss ads that the Commission has challenged since
1995. The year                   Figure 2: Ad Frequency Comparison
1992         was
selected for
comparison
because it
allowed us to
compare ads
that appeared
after the FDA
promulgated its
final rule on
weight-loss products with ads appearing after the passage of the Dietary Supplement Health and
Education Act (DSHEA). (See Section V.C for a detailed discussion of DSHEA).

        The change in the extent and tenor of weight-loss advertising has been dramatic. Compared to
1992, readers of the selected magazines saw more diet ads, more often, and for more products.
As detailed in Figure 2, the number of times weight-loss advertisements appeared in these magazines
increased 129%, the number of distinct advertisements increased 212%, and the number of
products increased 157%.

         There was also a major shift in the types of         Table 10: Product Comparison
weight-loss products and services advertised. In 1992, meal
replacement products such as Ultra Slim FastTM and Weight      Product Type         1992     2001
WatchersTM topped the list of advertised products. By         Meal Replacements     4        3
contrast, in 2001, two-thirds of the weight-loss
                                                              OTC Drugs             2        0
products promoted in the magazine sample were for
dietary supplements. (Table 10)                               Exercise Equipment    1        0

                                                              Dietary Supplements   0        12
        Techniques used to promote weight-loss products
                                                              Topical Treatments    0        1
have changed as well. The 2001 advertisements were
much more likely than the 1992 ads to use compelling          Food                  0        1

before-and-after photos, promise permanent weight loss,       Diet Center           0        1
guarantee weight-loss success, claim that weight loss


                                                 21
could be achieved without diet and exercise, claim that results could be achieved quickly, claim that the
product is all natural, and make express or
implied claims that the product is safe. (Figure   Figure 3: Advertising Techniques Comparison
3) Perhaps the most striking change is in the use Percent of ads employing technique
of consumer testimonials. In 1992, only one of
the eight ads (12.5%) used a consumer
testimonial and in that case the ad did not
specify the exact amount of weight lost. By
contrast, 76% of the 2001 ads used consumer
testimonials, and all claimed a specific amount
of inches or weight lost. In some cases, the
reports were extreme to the point of being
absurd: 44 lbs. in 30 days; 54 lbs. in 6 weeks;
and 120 lbs. in 7 weeks. On the other hand,
there did not appear to be a significant
difference in the percent of ads using claims
that weight-loss benefits were scientifically
proven (25% for 1992 vs. 28% for 2001) or
the use of medical professionals to endorse
products (12.5% for 1992 vs. 16% for 2001). It
should be noted, however, that given the
greater frequency of 2001 ads, the total
number of ads using these techniques has
increased.

       It appears that the rhetoric of weight-loss advertising has changed significantly. The list below
compares examples of claims made in 1992 with 2001. In each case, we attempted to capture the
theme of the advertisement.

                                                        1992

        •        Give us a week, we‟ll take off the weight.

        •        Finally a plan that really works.

        •        Guilt free eating from morning till night.

        •        Just think, now you can indulge in the foods you love, without the guilt.

        •        In universities across the country, clinical studies prove that four out of five people lost weight
                 with Dexatrim.

        •        It‟s all the nutrition her body needs and everything she wants to slide into something sexy.

        •        The only sure way to take body fat off and keep it off is to lower your set point. And the only
                 way to do that is aerobic exercise.


                                                         22
2001

•   You could lose 8 to 10 pounds per week, easily, . . . and you won‟t gain the weight back
    afterwards.

•   Reduces body fat deposits in your belly, thighs and butt.

•   Lose up to 2 pounds daily...without diet or exercise!

•   A natural way to jumpstart your weight loss.

•   I lost 120 LBS.

•   Pounds come off slowly but steadily.

•   In six months I lost 40 pounds, and have maintained my weight for eight months.

•   Makes sure that the fat from your last meal leaves your body before being digested.

•   An intake of 4000 calories a day can actually help you lose weight instead of gain it.

•   The only thermogenic diet supplement that has been clinically proven to increase fat-loss by a
    phenomenal 38.6 times more than diet and exercise alone.

•   A revolutionary thermogenic diet supplement clinically shown to increase fat-loss by an
    astounding 17 times more than diet and exercise alone.

•   Weight loss breakthrough “Do you have 48 hours to lose weight?”

•   Lose 10 lbs. and unwanted inches in 48 hours. Guaranteed!

•   Can help you achieve weight loss through detoxification in just two days.

•   We guarantee that you‟ll lose between 2 and 8 lbs a week . . . and you won‟t put the fat back
    on.

•   I lost 68 pounds.

•   Clinically proven . . . uses this technology to give you a better body without spending
    countless hours dieting or working out.

•   As you‟re dieting you‟ll lose weight in the right places and drop clothes sizes without the
    dreaded Yo-Yo effect.

•   Scientifically formulated to help you achieve your weight loss goals.

•   By summer you can lose ten pounds (or more)!

•   True weight loss success occurs when you eat right.

•   I Cheat! Don‟t you?




                                            23
•       I learned that losing weight requires much more than just dieting - it takes a whole lifestyle
                change.

        •       You could lose up to 10 lbs. this weekend!

        •       Curbs cravings . . . reduces calorie absorption


          Although both the 1992 and 2001 examples include unobjectionable statements, as well as
facially questionable claims, the 2001 advertisements appear to be more likely to make specific
performance promises that are deceptive and misleading. For example, 31% of the 2001 ads made
at least one representation that almost certainly is false, compared to zero percent in 1992. These
ads appeared in Family Circle, Cosmopolitan, Women’s Day, McCall’s, and Redbook.

        On its face, although not conclusive, this comparison of 1992 and 2001 ads supports the
following observations:

        C       The amount of weight-loss advertising has increased dramatically since 1992.

        C       The increase in weight-loss advertising is due to the explosion in the number of
                dietary supplement products now being promoted for weight loss.

        C       The use of consumer testimonials claiming substantial, specified amounts of weight
                loss has increased significantly.

        C       The use of specific performance claims, including claims that on their face are almost
                certainly false, has proliferated.

          This report looked at only specific magazines and compared only ads appearing during a
four-month period in 2001 with ads appearing in the same months for 1992. Without additional
supporting evidence, these results cannot be extrapolated to other forms of media. Moreover, there
may be alternative explanations for the apparent increase in deceptive ads in these publications that
would not necessarily mean that there has been an overall increase in deceptive weight-loss product
advertising. For example, it is possible that ads have shifted from other forms of media, such as
supermarket tabloids, to these magazines. Nevertheless, the observed results are consistent with the FTC
staff‟s general impressions in monitoring weight loss advertising.

       The review set forth above suggests that weight-loss product and service advertising is
permeated with false and misleading representations. Moreover, this type of advertising appears to be
on the rise. At the same time, as detailed in the following section, there has been an historically
unprecedented level of law enforcement aimed at preventing this type of advertising.




                                                        24
V. Regulatory Framework

         The FTC and the FDA have concurrent jurisdiction over weight-loss products. The FTC has
primary jurisdiction over the advertising of over-the-counter drug products, devices, and dietary
supplements.43 The FDA has primary jurisdiction over the labeling of over-the-counter drug products and
dietary supplements and the advertising and labeling of prescription drug products.44

         A. Legal Standards Applicable to Weight-loss Advertising

       Under the FTC Act, the advertising of products and services for weight loss is governed by the
same legal standards that apply to all other product and service promotions. The two basic principles
of FTC advertising law45 are that: 1) the ad must be truthful and not misleading; and 2) before
disseminating an ad, advertisers46 must have adequate substantiation for all objective product claims.47

         The FTC‟s substantiation requirement applies to both express and implied claims. Thus, for
example, FTC law prohibits an advertisement containing the statement that “I‟m 5' 4" and weighed 200
pounds before I started taking product X, now I weigh 110,” if supporting research does not
substantiate the underlying claim that product X would enable a user to lose substantial weight, including as much
as ninety pounds.

           The level of substantiation required depends in large part on the specific claim being made and
how it is presented and qualified. For instance, an ad claiming that “Scientists Now Agree” likely
would be held to a scientific consensus standard, and the advertiser would have to show that scientists
in fact agree. Where no specific level of support is stated, the FTC requires “competent and reliable
scientific” evidence to substantiate weight loss, and other health-related, advertising claims. In general,
competent and reliable scientific evidence consists of tests, studies, or other scientific evidence that has
been conducted and evaluated according to standards that experts in the field accept as accurate and
reliable. Under the FTC Act, anecdotal reports, articles in popular magazines, opinions, and
inadequately controlled open label studies are not considered adequate substantiation and cannot be
used as substitutes for scientific support.48

         Moreover, study results must be relevant to the claims being made for the product. Studies that test
different ingredients or that test ingredients at a substantially different dose level than that contained in the product
being marketed are not adequate substantiation. In addition, the study population and
conditions of use must be consistent with the advertising claims. Studies that are limited to specific
populations may not apply to other populations. Finally, if an advertisement claims that a product
causes weight loss without dietary modifications, then it may not be appropriate to extrapolate results
from studies using restricted caloric intake.49

         B. FTC Enforcement History

       The FTC filed its first weight-loss case in 1927.50 The product was called McGowan‟s
Reducine, and advertisements that appeared in True Romances magazine claimed that “excess fat is

                                                         25
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs
5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs

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5 Tips to Lose Stomach Fat, Get Flat Six Pack Abs

  • 1. ederal Trade Commissioi www.actionweightloss.com An Analysis of Current Trends A FEDERAL TRADE COMMISSION STAFF REPORT September 2002
  • 2. www.actionweightloss.com An Analysis of Current Trends A REPORT OF THE STAFF OF THE FEDERAL TRADE COMMISSION September 2002
  • 3. FEDERAL TRADE COMMISSION TIMOTHY J. MURIS, Chairman SHEILA F. ANTHONY, Commissioner MOZELLE W. THOMPSON, Commissioner ORSON SWINDLE, Commissioner THOMAS B. LEARY, Commissioner This report is a project of the staff of the Federal Trade Commission with the assistance of the Partnership for Healthy Weight Management, a coalition of representatives from science, academia, the health care profession, government, commercial enterprises, and organizations whose mission is to promote sound guidance on strategies for achieving and maintaining a healthy weight. The principal authors of this report are attorneys with the Bureau of Consumer Protection, Federal Trade Commission. The views expressed in this report are those of the authors and do not necessarily represent the views of the Federal Trade Commission or any individual Commissioner. Special thanks are given to members of the Partnership, for their contributions to this report and to Michelle Rusk, an attorney with the Federal Trade Commission, for her assistance in editing this report, and Devenette Cox, who managed the data base for the report. The authors wish to acknowledge the contributions of Elizabeth Nichols, Eva Tayrose, Steve Sawchuk, Trisa Wilkens and Michelle Reeve for their assistance in the collection and coding of the advertisements reviewed in this report. i
  • 4. ii
  • 5. iii
  • 6. Introduction George L. Blackburn, M.D., Ph.D. As health care professionals, we are concerned about the epidemic of obesity: the relations between excess body weight and such medical conditions as cardiovascular disease, hypertension, type 2 diabetes, osteoarthritis, sleep apnea, and certain cancers (such as breast, ovarian, prostate and colon) are well established. We are equally concerned about false and misleading claims in the advertising of weight loss products and services. Many promise immediate success without the need to reduce caloric intake or increase physical activity. The use of deceptive, false, or misleading claims in weight loss advertising is rampant and potentially dangerous. Many supplements, in particular, are of unproven value or have been linked to serious health risks. A majority of adults in the United States are overweight or obese. All told, they invest over $30 billion a year in weight loss products and services. These consumers are entitled to accurate, reliable, and clearly-stated information on methods for weight management. They have a right to know if the weight loss products they're buying are helpful, useless, or even dangerous. For this reason, the staff of the Bureau of Consumer Protection, Federal Trade Commission (FTC), joined with the Partnership for Healthy Weight Management-a coalition of representatives from science, academia, the health care professions, government agencies, commercial enterprises, and public interest organizations--to collect and analyze weight loss advertising. The Partnership's purpose is to promote sound guidance to the general public on strategies for achieving and maintaining a healthy weight. This report by the FTC staff is a major advance in that direction. Evidence-based guidelines issued by the National Institutes of Health call for weight loss by simultaneously restricting caloric intake and increasing physical activity. Many studies demonstrate that obese adults can lose about 1 lb. per week and achieve a 5% to 15% weight loss by consuming 500 to 1,000 calories a day less than the caloric intake required for the maintenance of their current weight. Very low calorie diets result in faster weight loss, but lower rates of long-term success. While exercise added to caloric restriction can help overweight and obese people achieve minimally faster weight loss early on, physical activity appears to be a very important treatment component for long-term maintenance of a reduced body weight. To lose weight and not regain it, ongoing changes in thinking, eating, and exercise are essential. Behavioral treatments that motivate therapeutic lifestyle changes can promote long-term success by helping obese individuals make necessary cognitive and lifestyle changes. The public often perceives weight losses of 5% to 15% as small and insufficient even though they suffice to prevent and improve many of the medical problems associated with weight gain, iv
  • 7. overeating, and a sedentary lifestyle. Many in the weight loss industry promise effortless, fast weight loss, then support this misperception by bombarding Americans with spurious advertising messages touting physiologically impossible weight loss outcomes from the use of unproven products and services. All advertisers, whatever their choice of media--cable television, infomercials, radio, magazines, newspapers, supermarket tabloids, direct mail, or commercial e-mail and Internet websites--know that only those products and services that help people adopt lifestyles that balance caloric intake with caloric output will prevent and treat the disease of obesity. For certain businesses (weight loss franchises, pharmaceutical firms, food companies, the dietbook industry, makers of exercise equipment, suppliers of dietary supplements, to name a few) these deceptive and misleading advertisements prevent the public from hearing their messages, words that promote therapeutic lifestyle changes as advocated by professional societies and the U.S. Department of Health and Human Services. Data indicate that at any given time, almost 70 million Americans are trying to lose weight or prevent weight gain. In 2000 they spent approximately $35 billion on products they were told would help them achieve those objectives-- videos, tapes, books, medications, foods for special dietary purpose, dietary supplements, medical treatments, and other related goods and services. As with cigarette smoking and alcohol abuse, false or deceptive advertising of weight loss products and services puts people at risk. Many of the products and programs most heavily advertised are at best unproven and at worst unsafe. By promoting unrealistic expectations and false hopes, they doom current weight loss efforts to failure, and make future attempts less likely to succeed. In the absence of laws and regulations to protect the public against dangerous or misleading products, a priority exists for the media to willingly ascribe to the highest advertising standards, i.e., those that reject the creation and acceptance of advertisements that contain false or misleading weight loss claims. The public would be well served by becoming more knowledgeable about the evidence- based guidelines, the scientifically-proven and medically-safe standards that underlie national public health policy. When more people know what's important and realistic in achieving and maintaining a healthy body weight, fewer will be inclined to waste their money, time, and effort on dangerous fads or miracle cures. The staff of the FTC‟s Bureau of Consumer Protection has provided an analysis of current trends in weight loss advertising. It is now up to the consumer and media to act in the best interest of the public health. George L. Blackburn, M.D., Ph.D. S. Daniel Abraham Chair in Nutrition Medicine Harvard Medical School, Boston, MA Past President of The American Society for Clinical Nutrition, North American Association for the Study of Obesity, and the American Society for Parenteral and Enteral Nutrition v
  • 8. TABLE OF CONTENTS Introduction .............................................................................................................. iv Executive Summary ............................................................................................... vii I. An Overview ........................................................................................................ 1 A. A Never-Ending Quest for Easy Solutions ............................................ 1 B. The Role of Advertising for Weight-loss Products and Services .......... 2 C. Weight Loss: A Multi-Billion Dollar Industry..................................... 2 II. Collection Methodology and Coding ................................................................ 3 III. Analysis of Weight-loss Advertisements ........................................................ 5 A. General Observations ............................................................................. 5 B. Media and Product Types ........................................................................ 6 C. Claims by Category................................................................................ 7 1. Consumer Testimonials ............................................................. 9 2. Before/After Photos .................................................................... 11 3. Rapid Weight-loss Claims.......................................................... 13 4. Lose Weight Without Diet or Exercise ...................................... 14 5. Lose Weight Permanently .......................................................... 15 6. No Matter How Many Times You Have Failed Before .............. 16 7. Scientifically Proven/Doctor Endorsed ...................................... 17 8. Money-back Guarantees .............................................................. 18 9. Safe/All Natural Claims ............................................................. 19 IV. Historical Comparison: 1992/2001 ................................................................... 21 V. Regulatory Framework .................................................................................... 25 A. Legal Standards Applicable to Weight-loss Advertising...................... 25 B. FTC Enforcement History ..................................................................... 25 C. FDA Regulation of Weight-loss Products ............................................. 27 VI. Media Responsibility ....................................................................................... 28 VII. Conclusion ....................................................................................................... 30 Appendix A: Product List Appendix B: Examples of Questionable Ad Claims From 2001 Sample vi
  • 9. Executive Summary This report attempts to take a comprehensive look at weight loss advertising. The need to do so is compelling. In the last decade, the number of FTC law enforcement cases involving weight loss products or services equaled those filed in the previous seven decades. Consumers spend billions of dollars a year on weight loss products and services, money wasted if spent on worthless remedies. This report highlights the scope of the problem facing consumers as they consider the thousands of purported remedies on the market, as well as the serious challenge facing law enforcement agencies attempting to prevent deceptive advertising. According to the U.S. Surgeon General, overweight and obesity have reached epidemic proportions, afflicting 6 out of every 10 Americans. Overweight and obesity constitute the second leading cause of preventable death, after smoking, resulting in an estimated 300,000 deaths per year. The costs, direct and indirect, associated with overweight and obesity are estimated to exceed $100 billion a year. At the same time, survey data suggest that millions of Americans are trying to lose weight. The marketplace has responded with a proliferating array of products and services, many promising miraculous, quick-fix remedies. Tens of millions of consumers have turned to over-the-counter remedies, spending billions of dollars on products and services that purport to promote weight loss. In the end, these quick-fixes do nothing to address the nation‟s or the individual‟s weight problem, and, if anything, may contribute to an already serious health crisis. Once the province of supermarket tabloids and the back sections of certain magazines, over-the-top weight loss advertisements promising quick, easy weight loss are now pervasive in almost all media forms. At least that is the impression. But are the obviously deceptive advertisements really as widespread as they might appear watching late night television or leafing through magazines at the local newsstand? To answer this and other questions, we collected and analyzed a nonrandom sample of 300 advertisements, mostly disseminated during the first half of 2001, from broadcast and cable television, infomercials, radio, magazines, newspapers, supermarket tabloids, direct mail, commercial e-mail (spam), and Internet websites. In addition, to evaluate how weight-loss advertising has changed over the past decade, we collected ads disseminated in 1992 in eight national magazines to compare with ads appearing in 2001 in the same publications. We conclude that false or misleading claims are common in weight-loss advertising, and, based on our comparison of 1992 magazine ads with magazines ads for 2001, the number of products and the amount of advertising, much of it deceptive, appears to have increased dramatically over the last decade. Of particular concern in ads in 2001 are grossly exaggerated or clearly unsubstantiated vii
  • 10. performance claims. Although we did not evaluate the substantiation for specific products and advertising claims as part of this report, many of the claims we reviewed are so contrary to existing scientific evidence, or so clearly unsupported by the available evidence, that there is little doubt that they are false or deceptive. In addition to the obviously false claims, many other advertisements contain claims that appear likely to be misleading or unsubstantiated. Falling into the too-good-to-be-true category are claims that: the user can lose a pound a day or more over extended periods of time; that substantial weight loss (without surgery) can be achieved without diet or exercise; and that users can lose weight regardless of how much they eat. Also falling into this category are claims that a diet pill can cause weight loss in selective parts of the body or block absorption of all fat in the diet. These types of claims are simply inconsistent with existing scientific knowledge. This report catalogues the most common marketing techniques used in 300 weight loss advertisements. Nearly all of the ads reviewed used at least one and sometimes several of the following techniques, many of which should raise red flags about the veracity of the claims. Consumer Testimonials; Before/After Photos. The headline proclaimed: “I lost 46 lbs in 30 days.” Another blared, “How I lost 54 pounds without dieting or medication in less than 6 weeks!” The use of consumer testimonials is pervasive in weight-loss advertising. One hundred and ninety-five (65%) of the advertisements in the sample used consumer testimonials and 42% contained before-and-after pictures. These testimonials and photos rarely portrayed realistic weight loss. The average for the largest amount of weight loss reported in each of the 195 advertisements was 71 pounds. Fifty-seven ads reported weight loss exceeding 70 pounds, and 38 ads reported weight loss exceeding 100 pounds. The advertised weight loss ranges are, in all likelihood, simply not achievable for the products being promoted. Thirty-six ads used 71 different testimonials claiming weight loss of nearly a pound a day for time periods of 13 days or more. Rapid Weight-loss Claims. Rapid weight-loss claims were made in 57% of the advertisements in the sample. In some cases, the falsity of such claims is obvious, as in the ad that claimed that users could lose up to 8 to 10 pounds per week while using the advertised product. No Diet or Exercise Required. Despite the well-accepted prescription of diet and exercise for successful weight management, 42% of all of the ads reviewed promote an array of quick-fix pills, patches, potions, and programs for effortless weight loss and 64% of those ads also promised fast results. The ads claim that results can be achieved without reducing caloric intake or increasing physical activity. Some even go so far as to tell consumers “you can eat as much as you want and still lose weight.” Long-term/Permanent Weight-loss Claims. “Take it off and keep it off” (long- term/permanent weight loss) claims were used in 41% of the ads in the sample. In fact, the publicly viii
  • 11. available scientific research contains very little that would substantiate long-term or permanent weight-loss claims for most of today‟s popular diet products. Accordingly, long-term or permanent weight-loss claims are inherently suspect. Clinically Proven/Doctor Approved Claims. Clinically proven and doctor approved claims are also fairly common in weight-loss advertisements, the former occurring in 40% and the latter in 25% of the ads in the sample. Some of the specific claims are virtually meaningless. For example, a representation such as, “Clinical studies show people lost 300% more weight even without dieting,” may cause consumers to conclude mistakenly that the clinically proven benefits are substantial, whereas, in fact, the difference between use of the product and dieting alone could be quite small (1.5 lbs. vs. .5 lbs.). These claims do little to inform consumers and most ads fail to provide consumers with sufficient information to allow them to verify the advertisers‟ representations. Moreover, the Federal Trade Commission, in past law enforcement actions, has evaluated the available scientific evidence for many of the ingredients expressly advertised as clinically proven, and challenged the weight-loss efficacy claims for these ingredients. Natural/Safe Weight-loss Claims. Safety claims are also prevalent in weight-loss advertising. Nearly half of all the ads in the sample (42%) contained specific claims that the advertised products or services are safe and 71% of those ads also claimed that the products were “all natural.” Safety claims can be difficult to evaluate, especially when so many ads fail to disclose the active ingredients in the product. On the other hand, some advertisements disclose ingredients, e.g., ephedra alkaloids, that make unqualified safety claims misleading. Nevertheless, marketers in almost half (48%) of the ads that identified ephedra as a product ingredient made safety claims. Only 30% of the ads that identified ephedra as an ingredient included a specific health warning about its potential adverse effects. Historical Comparison. To develop a perspective on how weight-loss advertising has changed over time, this report also compares advertisements appearing in a sample of magazines published in 2001 with ads in the same magazines in 1992. Compared to 1992, readers in 2001 saw more diet ads, more often, and for more products. Specifically, C The frequency of weight-loss advertisements in these magazines more than doubled, and C The number of separate and distinct advertisements tripled. Moreover, the type of weight-loss products and services advertised dramatically shifted from “meal replacements” (57%), in 1992 to dietary supplements (66%), in 2001. Meal replacement products typically facilitate the reduction of caloric intake by replacing high-calorie foods with lower-calorie ix
  • 12. substitutes, whereas dietary supplements are commonly marketed (55%) with claims that reducing caloric intake or increasing physical activity is unnecessary. The considerable changes in the methods used to promote weight-loss products are the most revealing indication of the downward spiral to deception in weight-loss advertising. The 2001 advertisements were much more likely than the 1992 ads to use dramatic consumer testimonials and before-and-after photos, promise permanent weight loss, guarantee weight-loss success, claim that weight loss can be achieved without diet or exercise, claim that results can be achieved quickly, claim that the product is all natural, and make express or implied claims that the product is safe. Finally, although both the 1992 and 2001 examples include unobjectionable representations, as well as almost certainly false claims, the 2001 advertisements appear much more likely to make specific performance promises that are misleading. Conclusion. The use of false or misleading claims in weight-loss advertising is rampant. Nearly 40% of the ads in our sample made at least one representation that almost certainly is false and 55% of the ads made at least one representation that is very likely to be false or, at the very least, lacks adequate substantiation. The proliferation of such ads has proceeded in the face of, and in spite of, an unprecedented level of FTC enforcement activity, including the filing of more than 80 cases during the last decade. The need for critical evaluation seems readily apparent. Government agencies with oversight over weight-loss advertising must continually reassess the effectiveness of enforcement and consumer and business education strategies. Trade associations and self- regulatory groups must do a better job of educating their members about standards for truthful advertising and enforcing those standards. The media must be encouraged to adopt meaningful clearance standards that weed out facially deceptive or misleading weight-loss claims. The past efforts of the FTC and the others to encourage the adoption of media screening standards have been largely unsuccessful. Nevertheless, as this report demonstrates, the adoption and enforcement of standards would reduce the amount of blatantly deceptive advertising disseminated to consumers and efforts to encourage the adoption of such standards should continue. Finally, individual consumers must become more knowledgeable about the importance of achieving and maintaining healthy weight, more informed about how to shop for weight-loss products and services, and more skeptical of ads promising quick-fixes. x
  • 13. I. An Overview A. A Never-Ending Quest for Easy Solutions Since at least 1900, American consumers have been searching for a safe and effective way to lose weight. As a nation, it has been a losing battle. Overweight and obesity have reached epidemic proportions.1 An estimated 61 percent of U.S. adults are overweight or obese, and the trend is in the wrong direction.2 Overweight and obesity constitute the second leading cause of preventable death, after smoking, resulting in an estimated 300,000 deaths per year at a cost (direct and indirect) that exceeds $100 billion a year.3 The struggle to shed unwanted pounds usually resolves itself into choosing between responsible products or programs that offer methods for achieving moderate weight loss over time and “miracle” products or services that promise fast and easy weight loss without sacrifice. Over the course of the last century, popular weight-loss methods have included: prescription and over- the-counter drugs and dietary supplements; surgical procedures such as gastro-intestinal bypass surgery, gastroplasty (stomach stapling), and jaw wiring; the television shows of motivational weightloss gurus; commercial weight-loss centers; commercial diet drinks; doctor-supervised very-low- calorie diets, complete with their own vitamin shots, fiber cookies, and drinks; the development of fat-free, low-fat, fake-fat, and sugar-free foods; weight-loss support groups; exercise trends such as aerobics and body building; and cellulite creams. Almost all weight-loss experts agree that the key to long-term weight management lies in permanent lifestyle changes that include, among other things, a nutritious diet at a moderate caloric level and regular physical exercise. Nevertheless, advertisements for weight-loss products and services saturate the marketplace, with many promising instantaneous success without the need to reduce caloric intake or increase physical activity. This is not a new phenomenon. In the last 100 years, various types of weight loss products and programs have gained and lost popularity, ranging from the ludicrous - diet bath powders, soaps, and shoe inserts - to the dangerous, such as the fen/phen diet pill combination.4 Around the 1900s, popular weight-loss drugs included animal-derived thyroid, laxatives, and the poisons arsenic and strychnine; eventually each was shown to cause weight loss only temporarily, and usually to be unsafe to use. In the 1930s, doctors prescribed dinitrophenol, a synthetic insecticide and herbicide that increases human metabolism so drastically that organs fail, causing blindness and other health problems. The hormone human chorionic gonadotropin (HCG) became popular in the 1950s for weight loss, and resurfaced recently, even though the FDA exposed it decades ago as effective only to treat Fröhlich‟s Syndrome, a particular genetic imbalance occurring only in boys.5 The 1990s saw an explosion in dietary supplement marketing, many of which are of unproven value and/or have been linked to serious health risks.6 As discussed in this report, the 1
  • 14. Federal Trade Commission has brought numerous cases against the advertisers of weight-loss supplements for making false or misleading advertising claims. Other products may raise serious safety concerns. For example, experts, including the American Medical Association, have raised concerns about the safety of ephedra, a popular diet pill ingredient,7 and Health Canada recently warned Canadian citizens against using ephedra for dieting because of its dangerous propensities.8 B. The Role of Advertising for Weight-loss Products and Services As noted above, consumers may choose from a myriad of weight-loss products and services. Consumers make their selections based, in part, on advertising. Advertising that presents false or misleading information may distort consumer decision making. Even more troubling, if the entire field of weight-loss advertising is subject to wide-spread deception, then advertising loses its important role in the efficient allocation of resources in a free-market economy. If the purveyors of the “fast and easy fixes” drive the marketplace, then others may feel compelled to follow suit or risk losing market share to the hucksters who promise the impossible. Public health suffers as well. The deceptive promotion of quick and easy weight-loss solutions potentially fuels unrealistic expectations on the part of consumers. Consumers who believe that it is really possible to lose a pound a day may quickly lose interest in losing a pound or less a week. C. Weight Loss: A Multi-Billion Dollar Industry More than two thirds of American adults are trying either to lose weight or to forestall weight gain, according to a 1996 survey of 107,000 people by the Centers for Disease Control and Prevention (“CDC”).9 The nearly 29 percent of men and 44 percent of women who are trying to lose weight10 (an estimated 68 million American adults) comprise a huge potential market for sellers of weight-loss products and services. No wonder overall sales in the weight-loss/weight-control industry are burgeoning. According to an article in the Atlanta Business Chronicle, consumers spent an estimated $34.7 billion in 2000 on weight-loss products and programs.11 This figure includes sales of books, videos, and tapes, low-calorie foods and drinks, sugar substitutes, meal replacements, prescription drugs, over-the-counter drugs, dietary supplements, medical treatments, commercial weight-loss chains, and other products or services related to weight-loss or weight- maintenance. Although total sales information is not available, the figures that are available are impressively large. For example, year 2000 sales for the eight largest weight-loss chains totaled $788 million, and sales for dietary supplements that purport to promote weight loss accounted for $279 million in retail outlets alone.12 In a report from the Business Communications Company based on 1999 figures, total sales for weight-loss supplements were estimated at $4.6 billion.13 This corresponds with estimates from the CDC, based on a five-state random-digit telephone survey, that 7% of the adult population used one or more non-prescription weight-loss products during 1996 through 1998.14 The authors extrapolate from this survey that an estimated 17.2 million Americans used 2
  • 15. nonprescription weight-loss products during this time period.15 The amount of total sales for unproven or worthless products is not known, but it is substantial. Infomercials, direct mail advertising, and free-standing inserts can generate tens of millions of dollars in sales within a short period of time for a single product, and, as this report demonstrates, there are hundreds, perhaps even thousands, of weight-loss products on the market. These forms of saturation advertising do not require high response rates to be highly profitable. As an example of the prevalence of hard-sell marketing for non-prescription weight-loss products, spending on infomercials (usually 30-minute to an hour programs pitching products for direct sale via telephone call-ins) for weight-loss and nutrition products exceeded $107 million in 1999.16 The alarming increase in overweight and obesity combined with marketers‟ easy access to mass media outlets makes the business of weight loss a booming enterprise. II. Collection Methodology and Coding This report looks at weight-loss advertising disseminated through broadcast and cable television, infomercials, radio, magazines, newspapers (including free-standing inserts in Sunday newspapers), supermarket tabloids, direct mail, commercial e-mail (spam), and Internet websites. We collected a total of 300 advertisements from a variety of sources. Except as noted with regard to Internet sites, we did not attempt to select a scientifically random sample.17 At the same time, no effort was made to collect just “bad” ads. In general, these advertisements appeared between February and May 2001. Television and radio advertisements: Members of the Partnership for Healthy Weight Management18 (the Partnership) monitored television and radio advertisements and sent identifying information to the FTC staff, who ordered copies of the ads from Video Monitoring Service. Twenty radio and television ads were included in our sample. Infomercials: The FTC staff obtained a list of twenty-eight infomercials appearing between January 1, 2001 and May 7, 2001 from Infomercial Monitoring Service, Inc. and ordered six infomercials, based on the product description and the date the infomercial initially aired. We gave preference to infomercials that appeared to involve relatively new products and excluded infomercials marketing exercise equipment and electronic devices. When there were two infomercials for the same product, we selected the infomercial with the most recent initial appearance date.19 Magazines and supermarket tabloids: The FTC staff selected the following magazines and supermarket tabloids for monitoring: Cosmopolitan, Family Circle, Fitness, First for women, Glamour, Globe, Ladies Home Journal, Let’s Live, Marie Claire, McCalls, National Enquirer, National Examiner, Redbook, Rosie, Self, Soap Opera Digest, Star, Sun, Weekly World News, Woman’s Day, Women’s Fitness, and Women’s Own. We selected some of the publications 3
  • 16. because of their past history of running questionable weight loss advertisements. With regard to magazines published on a monthly basis, we reviewed each issue from February through May for weight-loss advertisements. We reviewed only selected editions of weekly publications. Newspapers: The FTC staff obtained a sample of U.S. newspaper advertisements from Burrelle‟s Information Services, a newspaper clipping service. The ads appeared during April and the first week of May 2001. We included newspaper ads in our sample if they contained references to specific amounts of weight loss, e.g., lose 30 pounds by summer, or John Doe lost 30 pounds. Direct Mail and Unsolicited Commercial e-mail (spam): We collected direct mail and spam ads from the FTC staff, members of the Partnership, and consumers. Internet Ads: The Partnership and two Northern Illinois University researchers organized a "surf day" project to identify relevant websites. In December 2000, a student-team collected data, using 14 popular search engines and 139 keyword search terms, about Internet websites containing weight-loss related information.20 Through this process, participants located thousands of Internet websites. Researchers compiled URL and other information about the websites in a database. The FTC staff randomly selected every 50th still-active site in the database until it had accumulated a representative sample of 44 commercial sites that promoted weight-loss products and/or services. The FTC staff collected and coded the following information from each advertisement: company name; product name; product type, e.g., meal replacement; publication and publication dates; method of dissemination (broadcast TV, cable TV, infomercial, radio, magazine, newspaper, tabloid, direct mail, free standing insert, unsolicited commercial e-mail (spam), and Internet website); and purchase options (retail outlet, website, direct mail, telephone, other). The FTC staff also coded the use of the following specific types of claims or advertising techniques: consumer testimonials; before-and-after photos; rapid weight-loss claims; lose weight without diet or exercise claims; long-term or permanent weight-loss claims; representations that the user will not fail no matter how many times he or she has failed before; clinically or scientifically proven claims; endorsements by medical professionals; money-back guarantees; and all-natural and/or safe claims. The FTC staff also recorded the specific text of the headline and representative claims for analysis. We collected additional information from ads using consumer testimonials, including: the number of testimonials used; the high and low range of weight loss claimed, e.g., 10 lbs. in two weeks/30 lbs. in 30 days; whether there was a disclaimer associated with the use of the testimonials, what the disclaimer said, and whether the disclaimer was conspicuous. With regard to safety, we collected information on whether potential side effects were disclosed. Where there was a safety warning, we recorded the text of the warning. The FTC staff 4
  • 17. collected information concerning the active ingredients in the product if the advertisement provided that information. III. Analysis of Weight-loss Advertisements A. General Observations An ad for a product made from ground-up shells of shrimps, crabs, and lobsters claims, “Scientists dedicated years of research to come up with a high powered diet ingredient with no side effects” and asks, “Have you ever seen an overweight fish? Or an oyster with a few pounds too many? Everyone knows that sea animals never get fat.” A testimonial in this ad alludes to the product‟s ability to select only unwanted fat deposits: “The best thing about [the product] is that my waist size is 3 inches smaller, now only 26 inches. And it has taken off quite some inches from my butts [sic] (5 inches) and thighs (4 inches), my hips now measure only 35 inches. I still wear the same bra size though. The fat has disappeared from exactly the right places.” In fact, there is no convincing evidence that the shells of shrimps, crabs, or lobsters cause weight loss or that weight loss can be selectively targeted to specific parts of the body. An ad for a second product whose active ingredient is apple pectin is headlined, “LOSE UP TO 2 POUNDS DAILY... WITHOUT DIET OR EXERCISE! I LOST 44 POUNDS IN 30 DAYS!” The ad further claims that “Apple pectin is an energized enzyme that can ingest up to 900 times its own weight in fat. That's why it's a fantastic fat blocker.” The ad claims that the product can “eliminate fat for effortless weight loss” and that it produces the “same results as jogging 10 miles per week, an hour of aerobics per day, 15 hours of cycling or swimming per week.” In fact, there is no known pill that will cause up to two pounds of weight loss daily (with or without diet and exercise), and the claim of 44 pounds of weight loss in 30 days is not credible. In an infomercial for yet another weight-loss product, a beaming spokesperson and a purported scientific expert standing in front of a colorful pastry display assure viewers that to lose weight while using the product, “you don‟t really need any willpower. You don‟t have to diet or deprive yourself of foods in any way.” As the endorsers make these claims, the words “Call Now” and “Risk Free,” with the telephone number to order, appear in large, yellow text on one part of the screen on a blue background. At the same time, dim and indistinct white letters on a moving, mottled background advise, “A healthy diet and exercise are required to lose weight.” The world of weight-loss advertising is a virtual fantasy land where pounds “melt away” while “you continue to eat your favorite foods”; “amazing pills . . . seek and destroy enemy fat”; researchers at a German university discover the “amazing weight loss properties” of asparagus; and the weight-loss efficacy of another product is comparable to “running a 20 mile marathon while you sleep.” It‟s a world where, in spite of prevailing scientific opinion, no sacrifice is required to lose 5
  • 18. weight (“You don‟t change your eating habits and still lose weight”). Quick results are the (promised) norm ("The diet works three times faster than FASTING itself!"). You can learn how to lose weight with "No exercise. No drugs. No pills. And eat as much as you want - the more you eat, the more you lose." There is no need to worry because the products are “safe,” “risk free,” and/or “natural,” and some marketers are so concerned for your safety that they warn you to cut back if you lose too much weight (“If you begin to lose weight too quickly, take a few days off!!!”). You can always get your money back because so many of these “amazing” products are “guaranteed” (“. . .we‟ll give you your money back. Straight away. No questions asked”). And for those who remain skeptical, there is an answer. The products are backed by “clinical studies” or are “clinically tested” (“Clinical and laboratory tests at leading universities and hospitals, have proven that this product is effective”). Even if they do not purport to be clinically proven, many claim to be the product of years of scientific research (“Scientists dedicated years of research to come up with a high powered diet ingredient with no side effects”) or are “doctor recommended.” Moreover, according to many of the ads, you can “stay slim forever” because the weight loss is “permanent” (“I can still eat whatever I want without any danger of gaining the weight back.”). Finally, you can say good-bye to the Table 1: Number of Ads by Media Type failure syndrome because no matter how many times you‟ve tried to lose weight in the past, the Medium Number of Ads product will give you the “secret to lasting weight loss Newspaper/FSI 85 success.” Magazine 68 B. Media and Product Types Tabloids 19 Three hundred advertisements for 218 Internet 44 different products or services were collected and Commercial email 41 reviewed. A list of the products is included in Direct Mail 27 Appendix A. Table 1 identifies the number of ads for each type of medium.21 Radio 13 Broadcast 7 The advertisements covered virtually every kind of product or service imaginable. Categories Infomercial 5 with 10 or more advertisements included: dietary supplements (157), meal replacements (e.g., diet shakes) (33), hypnosis (27), food (15), diet plans/programs/diet centers (21), transdermal products (patches and creams) (11), and wraps (10). Some ads promoted multiple products, and in some instances, it was not possible to determine the product category based solely on the advertisement. Only about half (49%) of the advertisements for dietary supplement or transdermal products disclosed the product‟s active ingredients in the 6
  • 19. advertisement. Of those that identified ingredients, the most common were ephedra, chitosan, and chromium.22 C. Claims by Category A clear pattern of claims and techniques emerged from our analysis. Nearly all of the ads reviewed used at least one and sometimes several of these techniques. Figure 1 shows the frequency of common advertising claims and techniques and what percentage of the 300 ads used the claim or technique. A composite ad showing the frequency of each claim or technique appears on page 8 of this report. Table 2 shows the percentage of ads by product category that contains the claims. The following sections discuss specific claims and techniques in detail. Figure 1: Prevalence of Claims - All Media 7
  • 20. Depici (in percentages) of what the FTC f trends in the language us"1 weightloss ads. 42% 34% 42%B ...AFTER weight only to gain it all back. h 57% With NordicaLite you see results Jayne Doe of Eerie, PA 65% lost on Nordical Lite... Jayne has kept her The miracle ingredients in NordicaLite have been 41% weight off for over 10 years! in a major university-based study in Gotoberg. Sweden. *• 40% NordicaLite is approved and ? endorsed by for use by their patients .ordicaLite make 44% 25% ^ / I* weight and st 42% •j.< TANCE 52% 'It* Please rush mo my order ASA P I understand that if I am not complete satisfied, I can return the shipmont for a (no questions asked).">^
  • 21. Card #: Exp Data: City: State: Zip: Charge my: QVisa D Mastercard in. loo much Might on Out program iioo down Signature: Tel. #:
  • 22. Table 2: Frequency of Claims by Product Category Dietary Hypnosis Meal Food Plans/ Wraps Trans- Other Supplement Replace- Programs dermal s ment / Products Diet (27) (33) (15) Centers (10) (11) (24) (157) (21) Testimonial 59% 96% 70% 80% 76% 50% 45% 63% s Fast Results 60% 59% 58% 33% 43% 90% 73% 42% Guaranteed 59% 93% 36% 7% 24% 60% 55% 42% results Natural 56% 11% 42% 47% 14% 50% 27% 33% No Diet or 55% 56% 12% 20% 14% 20% 27% 33% Exercise Long- 38% 100% 18% 27% 33% 60% 18% 50% Term/Perma nent Safe/No 55% 30% 27% 20% 24% 50% 36% 25% Side Effects Before-and- 33% 85% 36% 60% 76% 40% 36% 25% After Clinically 53% 0 36% 7% 10% 40% 82% 33% Proven No More 32% 89% 27% 20% 24% 20% 9% 38% Failure Medical 34% 7% 12% 7% 10% 0 36% 38% Approval Excessive 12% 4% 0 0 5% 0 9% 0 Wt. Loss Warning 1. Consumer Testimonials Consumer testimonials are pervasive in weight-loss advertising. Of the advertisements in the sample, 195 (65%) used consumer testimonials as a mechanism to promote the weight-loss product or service. The ads that used this technique contained about five testimonials on average, with some containing as many as 50 or more. Testimonials were most often used in ads promoting hypnosis. 9
  • 23. Testimonials rarely described modest or realistic successes, instead touting extraordinary and rapid weight loss. Nearly 90% of ads using consumer testimonials claimed specific amounts of weight loss and more than half (56%) included a specific time period for the largest amount of weight loss reported in the ad, e.g., “I lost 30 pounds in 30 days.” The average for the largest amount of weight loss reported in each of the 195 advertisements was about 71 pounds. Fifty- seven (57) ads (30%) reported weight loss exceeding 70 pounds, and 38 ads (20%) reported weight loss exceeding 100 pounds. In many instances ads used testimonials reporting weight loss in ranges that are, in all likelihood, simply not achievable for the products being promoted. Thirty-six ads used 71 different testimonials claiming weight loss of nearly a pound a day for time periods of 13 days or more. These ranged from claims of 22 pounds in 13 days to 120 pounds in seven weeks. All but three of these ads were for dietary supplement products. There are many examples of implausible testimonials but perhaps the most remarkable is this one from a woman who claimed: 7 weeks ago I weighed 268 lbs, now I am down to just 148 lbs! During this time I didn‟t change my eating habits at all: the pounds must have disappeared only due to the new slimming capsule. My appearance is so different that my friends actually believe that I had liposuction. The product featured in this advertisement claims to work by preventing the absorption of fat in the digestive system. In fact, weight loss of this magnitude would require a net calorie deficit of 8,571 calories per day over the course of seven weeks. Even complete fasting would not produce this kind of result. Nevertheless, this testimonial was disseminated to millions of Americans through Cosmopolitan, Soap Opera Digest, National Enquirer, Women’s Day, Let’s Live, Women’s Own, McCall’s, Star, and First for women. Testimonials in weight-loss advertisements appear to serve at least two functions. First, they convey an efficacy claim, i.e., the product works; and second, they attempt to minimize consumer skepticism. Many potential purchasers of weight-loss products have purchased other weight-loss products that failed. The challenge for the advertiser is to convince the purchaser that its product will work when all the others have not. One way to do that is to present the purchaser with examples of “real people” just like themselves who have used the product successfully. Indeed, in some instances, particularly infomercials, the endorser directly addresses viewers to reassure them that the product really worked when all other products and programs failed. Weight-loss testimonials convey more than a limited message about one person‟s experience. They also convey a very convincing claim to consumers that the product is effective and, in some instances, that the product will enable the user to experience similarly dramatic results. Thus, testimonials can be deceptive in at least three distinct ways. First, the testimonialist may not have experienced the reported result. Testimonials that claim that users lost more than 30 pounds in 10
  • 24. as little as 30 days likely fall into this category. Second, the reported weight loss may not be attributable to the product, but to other diet, exercise, or lifestyle changes. Third, an advertisement presenting testimonials claiming extreme and atypical weight loss as typical or ordinary experiences is likely to be deceptive without an indication of the more modest weight loss results that the typical user would experience using the product.23 Table 3: Sample disclaimers used in weight- loss advertisements. Typicality Disclaimers: The most common Results not typical and depends on diet way to address this last issue is through and training program. disclaimers. Seventy (70) of the 195 ads (36%) had some form of disclaimer addressing the issue of Results not typical. whether the reported results are meant to be Results may not be typical. representative of users of the product or service. In only 18 of the cases, however, was the Results may vary. disclaimer conspicuous or proximate to the Individual results vary and can be more or testimonials. In the vast majority of less than the results mentioned. advertisements, disclaimers were buried in fine print footnotes or, in video ads, flashed as a video Results Atypical. superscript too quickly for viewers to read. Table These results are not typical of every 3 provides a sample of disclaimers found in the client. As individuals vary, so do results. selected advertisements. Your results may vary. Some of these disclaimers do little to Benefits vary from each person. inform consumers that the results reported in the advertisements are, at best, extreme cases, and Results obtained with this program can and do that consumers should not expect to achieve vary. similar results. For example, a disclaimer telling Yes! These are actual comments from our consumers that “results may vary” tells consumers customers - girls just like you telling us almost nothing other than that everyone will not about the exceptional, non-typical results achieve 50 pounds of weight loss. With one or they got with our amazing weight loss two notable exceptions, advertisers made no effort to system. provide specific information about the actual weight loss the average consumer could expect using a particular product. 2. Before/After Photos Before-and-after photos, often appearing with testimonials, are commonly used in weight loss ads. Forty- two percent (42%) of the ads in this sample contained before-and-after pictures. More than just graphic consumer testimonials, these pictures try to create an image of what the consumers could accomplish personally if they only used the advertised product. Before-and-after pictures usually fall into one of two categories: (1) the illustrated personal testimonial, and (2) the 11
  • 25. clinical comparison of isolated body portions.24 The former type often contains the following elements: Before Picture: Snapshot quality photograph of the subject that incorporates poor posture, neutral facial expression, unkempt hair, unfashionable attire, poor lighting, and washed out skin tones. After Picture: Brightly lit (sometimes studio portrait quality) pose of smiling subject in fashionable, often skimpy, attire, shoulders held back, tummy tucked in, with a stylish hair style and carefully applied makeup. Eighty-eight percent (88%) of the ads with before-and-after pictures contained illustrated testimonials. In television spots and infomercials, this type of before-and-after treatment often incorporates a before photograph superimposed over a videotaped segment featuring the subject after using the advertised product or service making his/her videotaped testimonial. Another form of before-and-after illustration isolates one portion of a subject's anatomy, usually the waist or buttocks, to show purported results, sometimes in a progression of three or more photographs over a period of time. These pictures often emulate the kind of illustrations found in medical articles. A few ads (two in this sample) feature both types of before-and-after pictures. Eleven percent (11%) of the ads with before- and-after pictures featured “clinical” comparison pictures. Often the only discernable difference in the before picture and the after picture is a change in posture and body control. In the before picture the subject's shoulders are slumped, the abdominal muscles are relaxed, and the pelvis thrust forward to emphasize body fat. The after picture shows the subject holding in his/her abdomen and/or holding back his/her shoulders to emphasize lean body mass. A close examination of the before picture in this type of ad raises the question of whether the subject needed to lose weight and suggests that little or no weight was actually lost. 12
  • 26. Some before-and-after photographs clearly appear to have been altered, usually by placing an image of the after subject‟s head on the photographic image of another (very obese) subject‟s body. Finally, it is not always clear whether “clinical” before-and-after pictures are depicting the results from actual users of the advertised product or service or are intended merely to be illustrative of the product‟s or service's capacity to produce weight loss. 3. Rapid Weight-loss Claims Fifty-seven percent (57%) of the ads in our sample promised rapid weight Table 4: Representative Claims That Promise Fast Results loss, often claiming that excess weight or “This combination of plant extracts constitutes a weight-loss fat can disappear in a matter of days or plan that facilitates what is probably the fastest weight loss ever weeks. Claims in this category range observed from an entirely natural treatment.” (elixir purportedly containing 16 plant extracts) from explicit promises of rapid weight loss (“A Quick Weight Loss Plan For “Just fast and easy, effective weight loss!” (fucus vesiculosus) People In A Hurry” “RAPID WEIGHT LOSS IN 28 DAYS!” “Clinically “Lose 10 lbs. in 8 Days!” (apple cider vinegar) proven to help you lose weight . . . fast”) “Rapid weight loss in 28 days!” (ephedra) through claims for immediate or near immediate results (“Starts to work within “Knock off your unwanted weight and fat deposits at warp minutes” “Works in one minute” “You only speeds! You can lose 18 pounds in one week!” (ingredients not disclosed) have to stay on it 2 DAYS TO SEE RESULTS”) to promises of amounts of “Clinically proven to cause rapid loss of excess body fat.” weight loss over time periods that (phosphosterine) compute to rapid rates of weight loss. “Two clinically proven fat burning formulations that are (“YOU CAN LOSE 18 POUNDS IN guaranteed to get you there fast or it costs you absolutely ONE WEEK!” “lose up to 10 lbs in 48 nothing.” (ingredients not disclosed) hours”). Additional examples are set 13
  • 27. forth in Table 4. Even the product names (“Redu-Quick, “Slim Down Fast”) emphasize speedy results. Such results are not only unlikely, they would be accomplished at an increased risk to health. Rapid weight loss has been associated with an increased risk of developing gallstones.25 Consequently, responsible programs that offer proven means of rapid weight loss for obese patients with such diseases as coronary artery disease or Type II diabetes provide physician supervision while patients are actively losing weight. Rapid weight-loss claims often appeared in combination with the promise of easy weight loss (“Lose those pounds the quick and easy way,” “Lose weight while you sleep,” “Lose weight quickly and easily and keep it off”) without the need for diet or exercise. In 54% of the ads promising rapid weight loss, there are also claims for easy weight loss or weight loss without the need for changing diets or increasing exercise levels. 4. Lose Weight Without Diet or Exercise Despite the well-accepted prescription of diet and exercise for successful weight management,26 42% of all of the ads reviewed promote a dizzying array of quick-fix pills, patches, potions, and programs for effortless weight loss. An ad for an apple cider vinegar pill, for example, boasts that “you can eat as much as you want and still lose weight,” because “when properly distributed, an intake of Table 5: Lose Weight Without Diet or Exercise Claims 4,000 calories a day can actually help you lose weight “awesome attack on bulging fatty deposits . . . has virtually eliminated the need to diet.” (Konjac root pill) instead of gain it.” Another ad exclaims that a pill “They said it was impossible, but tests prove [that] my astounding purportedly containing the diet-free discovery melts away...5, 6, even 7 pounds of fat a day.” “herbal equivalents” of (ingredients not disclosed) ephedrine, caffeine, and “The most powerful diet pill ever discovered! No diet or workout required. aspirin, plus other ingredients, The secret weight-loss pill behind Fitness models, Show Biz and is “scientifically shown in a Entertainment professionals! No prescription required to order.” recent clinical study to elicit a (ingredients not disclosed) 613% greater rate of fat loss in non-exercising subjects as “lose up to 30 lbs . . . No impossible exercise! No missed meals! No boring foods or small portions!” (plant extract fucus vesiculosus) compared to subjects not using it.”27 Additional “lose up to 8 to 10 pounds per week . . . [n]o dieting, no strenuous examples are set forth in exercise.” (elixir purportedly containing 16 plant extracts) Table 5.28 “my 52 lbs of unwanted fat relaxed away without dieting or grueling exercise.” (hypnosis seminar) In addition, 64% of the ads containing the “no exercise...[a]nd eat as much as you want - the more you eat, the more effortless weight-loss claims you lose, we‟ll show you how.” (meal replacement) outlined above also promise 14
  • 28. that the advertised products and services will produce fast results. These ads include such claims as “[t]ake off up to 10 pounds and 6" in just 2 days...[n]o exercise,” “lose 3-4 pounds a week without dieting or exercise,” “[I]‟ve lost 68 lbs in 4 months...does not require restricted diets or exercise,” and “[I] ate more and exercised less and still lost 44 lbs.” 5. Lose Weight Permanently “You lose it. You gain it back. Use [the advertised product] with every diet program and keep it off.” Many consumers have lost weight only to gain it back again. In fact, studies indicate that most people who lose weight gain it back within five years.29 Consequently, “take it off and keep it off” claims are fairly common in weight-loss advertising. In spite of the blue-sky promises of many marketers (“Get weight off and keep it off,” “You won't gain the weight back afterwards, because your weight will have reached its equilibrium,” “Discover the secret to permanent weight loss”), experts have repeatedly observed that although persons generally lose weight while actively participating in a weight loss regimen treatment, they tend to regain the weight over time once treatment ends.30 According to the National Academy of Science Food and Nutrition Board, “Many programs and services exist to help individuals achieve weight control. But the limited studies paint a grim picture: those who complete weight-loss programs lose approximately 10 percent of their body weight only to regain two-thirds of it back within 1 year and almost all of it back within 5 years.”31 For persons who have lost weight in the Table 6: Long-term Weight Maintenance Claims and past only to gain it all back again, the appeal Other Related Claims of a “once and forever” weight-loss product can be strong, especially when combined with Percentage of ads with long-term 41% references to the syndrome of failure many maintenance claims dieters experience or the promise of Percentage of ads combining long- effortless, no-sacrifice weight-loss success. term maintenance claims with no diet 26% (Table 6) According to almost all weight-loss or exercise claims experts, if there is a key to long-term Percentage of ads combining long- maintenance success, it requires permanent term maintenance claims with 23% lifestyle changes on the part of the dieter: references to past failures nutritional eating at moderate caloric levels, a regular Percentage combining all three 15% physical fitness routine, and abandonment of old habits that may have contributed to weight gain.32 The publicly available scientific research contains very little evidence that would substantiate long-term or permanent weight-loss claims for most of today‟s popular diet products. Experts usually insist on studies going out at least one year, if not two, in order to substantiate a claim for long-term weight-loss maintenance.33 Reliable studies of the long-term effectiveness of weight-loss products and programs are difficult and expensive to conduct. Not many marketers are likely to want to spend the money and the time necessary to have such tests of their product‟s effectiveness 15
  • 29. done. But that does not prevent many of them from assuring consumers that their product or service is “the secret to permanent weight loss” or that “you may never need to diet again.” 6. No Matter How Many Times You Failed Before Among the weight-loss product advertisements surveyed, many contain “no more failure claims” that, although this may not be the first product tried, it will be the last. (Table 7) One marketer asks, for example: “Are you tired of fad diets that never seem to work? Are you frustrated when you gain back most or all of Table 7: No More Failure Claims the weight you lose? Are you fed up with throwing money down the drain on diets that Percentage of ads with no more failure don‟t work?” This marketer, of course, claims 34% claims to offer the one product that will finally Percentage of ads with no more failure work. claims and long term/permanent claims 23% Percentage of ads with no more failure Many advertisers take an empathetic claims and testimonials 29% and understanding tone, assuring consumers that they are not to blame for their failure to lose weight: Dear Friend: If you‟ve ever tried losing weight using one of the hundred diets programs available, you know how difficult and frustrating it can be. And you are not alone. Most people who sincerely - even desperately - want to lose weight have never been successful on a diet. That‟s because diets do not work. Others take advantage of the difficulty many consumers have in maintaining lost weight: You‟ve been there. You want to lose weight, and you‟ve been successful before. But after a while, you‟re right back where you started - and the pounds always seem to come back . . . [The advertised product] can help you break the cycle. This advertising technique frequently takes the form of a testimonial from a product user who confides that he or she has experienced the same weight-loss frustrations: Discouraged, I started trying all the tricks, appetite suppressants, creams, diets and medications. Fads came and went and I had spent a fortune with no result. Of course, I tried to lose weight numerous times. But each new diet left me starved and deprived. I‟d lose weight, but end up irritable and unhappy. Diets weakened me physically and emotionally. I once lost all my weight on a liquid fast. It was incredibly expensive. Of course, the weight came right back on. As a result of extravagant advertising claims such as the ones described in this report, consumers may develop unrealistic notions about how much weight they can lose or keep off. 16
  • 30. Consumers purchase products purporting to be “unique” or “revolutionary” in their effectiveness and experience failure after failure. 7. Scientifically Proven/Doctor Endorsed Many marketers attempt to bolster the credibility of their claims by asserting that the advertised product has been scientifically tested and proven to work. (Table 8) Phrases like “the clinically proven healthy way to lose weight,” “clinically tested,” “scientifically proven,” and “studies confirm” bestow products with an aura of scientific legitimacy and aim to persuade consumers that they should feel confident that a product will Table 8: Clinically Proven, Medically Approved Claims work. Several advertisements describe the Percentage of all ads with clinically dramatic results obtained in clinical studies. proven claims 40% One advertisement, for example, asserts that Percentage of ads with medical “Clinical studies show people lost 300% approval claims 25% more weight even without dieting.”34 Many Percentage of ads with both advertisements also tout the fact that clinically proven and medical products were either developed or tested at approval claims 17% well-known, respected, and “independent” institutions, such as “major universities,” “a leading U.S. medical center,” or “leading hospital[s].” Other advertisements showcase the impressive credentials of the researchers conducting the studies supporting the product, such as an advertisement that claims that a study proving the efficacy of the product was conducted by “the country‟s most respected scientists.” Many advertisers also imply that there is a substantial body of competently conducted scientific research supporting the efficacy of the product.35 For instance, one advertisement claims that the efficacy of a product is “[b]acked by volumes of independent research and hundreds of published studies by the most prominent universities and medical journals in the world.” Another marketer claims that "[s]cientists dedicated years of research to come up with a high powered diet ingredient [contained in the product] with no side effects.” Although some advertisements briefly describe the results, and provide some information about the methodology, of a particular study, such as the study‟s duration and number of participating subjects, most of the advertisements fail to give consumers sufficient detail about a study to allow consumers to verify the advertiser‟s representations. Moreover, 20 of the 117 ads making “clinically proven” claims were for products that contained ingredients already evaluated by the Federal Trade Commission in the context of past law enforcement actions challenging specific weight loss claims. These ingredients, which include fucus vesiculosus, chromium, L-carnitine, chitosan, psyllium, 7-keto-DHEA, hydroxycitric acid, seaweed, konjac root, garcinia cambogia and glucomannan, were challenged based on insufficient scientific evidence to support the weight loss claims made in the advertisements. 17
  • 31. Still another technique that advertisers use to convince consumers that they are buying a tested and proven product is to assure consumers that a product is “recommended,” “approved by,” and often “developed” or “discovered” by a medical professional. (Table 8) For example, several advertisements prominently feature a “physician” wearing a white lab coat and a stethoscope and sitting in front of a diploma-filled wall. To add an air of legitimacy to the advertised product, some advertisements appear to be written by a physician. Others feature interviews with doctors or researchers who tout the product as being safe and effective. One Internet site even invites customers to call a “Medical Advisory Board” staffed with “qualified medical professionals” to answer medical questions. Expert endorsements, however, can be misleading. For example, an advertisement may fail to disclose that the medical professional endorsing the product has a financial interest in promoting the sale of the product - a fact likely to affect the weight consumers give the endorsement and that could affect their purchase decision.36 Marketers may even use a fictitious medical professional to endorse their products.37 In other instances, experts either may not have actually reviewed the scientific evidence on the product or its ingredients or failed to utilize existing expert standards in conducting their review.38 8. Money-back Guarantees The analysis revealed that money-back guarantees are one of the most frequently used techniques in weight-loss advertising. Fifty-two percent (52%) of all the ads reviewed include this representation. (Table 9) One advertiser, for Table 9: Money-back Guarantees example, encourages consumers to pay the price of the product only if the product has Percentage of ads that promise helped the consumer slim down: “If not, send guaranteed results 52% it back and pay nothing. There will be no Percentage of ads that have both questions asked and you won‟t owe us a guaranteed results and no more dime.” Another advertiser advises failure claims 24% consumers that the company would not guarantee its products if they did not work as advertised: “Believe me, I am not a gambler. I would never provide such an opportunity if I wasn‟t totally convinced that this is the weight-loss breakthrough of the decade, and there‟s no need to worry about too many requests for refunds.” Although many companies guarantee “consumer satisfaction” in general, several advertisements make very specific guarantees: “Whether you diet or not, [the marketer] guarantees that you‟ll lose up to seven pounds in the first week and then one dress or pant size every two weeks thereafter, or pay nothing.” Another marketer promises consumers that, “no matter how many times you‟ve tried before . . . no matter how much weight you have to lose . . . no matter how sluggish your metabolism . . . you will lose up to 10 to 15 pounds in just one week . . . up to 35 pounds in 3 weeks. Yes. Guaranteed! You lose or it doesn‟t cost you a penny.” 18
  • 32. For any number of reasons, marketers may fail to honor refund requests at all or delay honoring them for months. In fact, the Federal Trade Commission has brought several cases against marketers failing to make refunds promised in their advertising.39 9. Safe/All Natural Claims Safety claims are a prevalent marketing technique in weight-loss advertising. Nearly half of all the ads in the sample (42%) contained specific claims that the advertised products or services are safe. These claims are made in a variety of ways. Some ads contain direct, unqualified representations about the safety of the product or service in producing weight loss, including such statements as “safe and effective,” “100% safe and natural,” “safe and gentle as a vitamin pill,” “safe, immediate weight loss,” and “safely lose up to 6 lbs of fat, fluid, and flesh in just the first 24 hours alone.” Others make direct comparisons between the safety of the product or service and other weight-loss methods, with claims like “safer than liposuction,” “safest and most effective strategy [for weight loss],” and “safest weight management system in the world.” Finally, some safety claims are combined with compelling assertions of scientific proof of safety. Examples of those claims include such statements as “proven safe and effective,” “proven 100% safe,” and “tested for years and found to be very safe.” Many other weight-loss advertisements strongly imply that the product or service is safe because it has no side effects, is not a prescription weight-loss drug, or contains no potentially harmful stimulants. These representations include claims like “no side effects,” “no dangerous pills or tablets to take,” “[pills] do not pose a health hazard,” “88% success rate with virtually no side effects,” “in no way can [product X] harm your health,” “no dangerous dehydration nor depression,” “contains no stimulants that can harm the heart, increase blood pressure...,” “skip risking your health [from prescription drugs],” and “none of the harmful side effects often associated with prescription diet products.” One ad claimed that “the active compound has been recognized by the FDA as safe and effective for weight loss.” Claims of “all natural” often appear in conjunction with safety claims. Almost three quarters (71%) of those ads containing safety claims also had “natural” claims. These two claims appeared in 30% of all the ads that we reviewed, often in the same sentence. Examples of combined claims include “100% natural with no side effects,” “all natural 100% safe,” “lose weight naturally, safely,” “100% natural so it‟s totally safe,” and “lose weight in an easy way that is natural and that won‟t hurt your body.” Overall, 44% of the ads that we reviewed. made some version of the “all natural” claim. Safety claims sometimes appeared in ads promoting the product in a way that could create the potential for injury. For example, 73% of the ads in our sample that contained safety claims also represented that the product or service would produce “fast,” “quick,” or “immediate” results. If the product actually worked as quickly as advertised, it could produce potentially dangerous results, because rapid weight loss and safety are antagonistic goals. In fact, rapid weight loss, if not closely monitored by a physician, can result in serious adverse health consequences.40 19
  • 33. Finally, of those weight-loss advertisements that contained safety claims, 27% also included some type of safety-related warning in the advertisements. These warnings varied widely in substance and detail. Some stated simply that you should “consult your doctor,” or “consult your physician before beginning this or any weight-loss or exercise program.” Others included more targeted warnings, such as “do not use this product if you have high blood pressure, are pregnant or breast feeding, or on medication for a heart condition.” Often, the safety warning is presented in a manner that viewers are likely not to notice it. One ad contained a warning about serious health effects: “[t]his product has ephedrine group alkaloids in the form of herbal extracts and may cause serious adverse health effects.” This ad also included the claim that the product was “shown to be safe by two independent laboratories.” Conflicting messages in an advertisement about safety may confuse consumers and, ultimately, may cause them to ignore safety-related warnings. Safety claims for weight-loss products are of serious concern. The primary concern is that potentially serious adverse health effects can result if the claim is untrue or the effects of a product are unproven. This concern is particularly important where the product may present special undisclosed risks for certain populations, such as pregnant women or nursing mothers, or where the long-term health effects are unknown. In addition, certain products or ingredients may interact adversely with other medications that consumers might be taking, or may exacerbate pre-existing health conditions faced by overweight and obese consumers, including, for example, heart disease, high blood pressure, and diabetes. Ephedra or ephedrine alkaloids, for example, may be associated with dangerous effects on the central nervous system and heart and may result in serious injury for some persons.41 Almost half (48%) of the ads that identified ephedra as a product ingredient made safety claims, yet only slightly more than half of those (55%) included a specific warning about the health risks of ephedra. Only 30% of all ads that identified ephedra as an ingredient included a specific health warning about its potential adverse effects. Even more disturbing from a safety perspective, fully 60% of ads that made safety claims did not identify ingredients at all. Consumers‟ inability to make informed decisions about the safety of such products clearly raises the potential for serious adverse health consequences. 20
  • 34. IV. Historical Comparison: 1992/2001 To develop a perspective on how weight-loss advertising has changed over time, we compared advertisements appearing in a sample of magazines published in February thru May 2001 with ads that appeared in the same magazines in February thru May 1992. The magazines selected were Family Circle, Cosmopolitan, Women’s Day, Glamour, McCall’s, Ladies Home Journal, Self, and Redbook.42 These magazines were selected because they have been in publication for more than 10 years and have a history of running weight-loss ads. With the exception of Self, each of these magazines has run one or more weight-loss ads that the Commission has challenged since 1995. The year Figure 2: Ad Frequency Comparison 1992 was selected for comparison because it allowed us to compare ads that appeared after the FDA promulgated its final rule on weight-loss products with ads appearing after the passage of the Dietary Supplement Health and Education Act (DSHEA). (See Section V.C for a detailed discussion of DSHEA). The change in the extent and tenor of weight-loss advertising has been dramatic. Compared to 1992, readers of the selected magazines saw more diet ads, more often, and for more products. As detailed in Figure 2, the number of times weight-loss advertisements appeared in these magazines increased 129%, the number of distinct advertisements increased 212%, and the number of products increased 157%. There was also a major shift in the types of Table 10: Product Comparison weight-loss products and services advertised. In 1992, meal replacement products such as Ultra Slim FastTM and Weight Product Type 1992 2001 WatchersTM topped the list of advertised products. By Meal Replacements 4 3 contrast, in 2001, two-thirds of the weight-loss OTC Drugs 2 0 products promoted in the magazine sample were for dietary supplements. (Table 10) Exercise Equipment 1 0 Dietary Supplements 0 12 Techniques used to promote weight-loss products Topical Treatments 0 1 have changed as well. The 2001 advertisements were much more likely than the 1992 ads to use compelling Food 0 1 before-and-after photos, promise permanent weight loss, Diet Center 0 1 guarantee weight-loss success, claim that weight loss 21
  • 35. could be achieved without diet and exercise, claim that results could be achieved quickly, claim that the product is all natural, and make express or implied claims that the product is safe. (Figure Figure 3: Advertising Techniques Comparison 3) Perhaps the most striking change is in the use Percent of ads employing technique of consumer testimonials. In 1992, only one of the eight ads (12.5%) used a consumer testimonial and in that case the ad did not specify the exact amount of weight lost. By contrast, 76% of the 2001 ads used consumer testimonials, and all claimed a specific amount of inches or weight lost. In some cases, the reports were extreme to the point of being absurd: 44 lbs. in 30 days; 54 lbs. in 6 weeks; and 120 lbs. in 7 weeks. On the other hand, there did not appear to be a significant difference in the percent of ads using claims that weight-loss benefits were scientifically proven (25% for 1992 vs. 28% for 2001) or the use of medical professionals to endorse products (12.5% for 1992 vs. 16% for 2001). It should be noted, however, that given the greater frequency of 2001 ads, the total number of ads using these techniques has increased. It appears that the rhetoric of weight-loss advertising has changed significantly. The list below compares examples of claims made in 1992 with 2001. In each case, we attempted to capture the theme of the advertisement. 1992 • Give us a week, we‟ll take off the weight. • Finally a plan that really works. • Guilt free eating from morning till night. • Just think, now you can indulge in the foods you love, without the guilt. • In universities across the country, clinical studies prove that four out of five people lost weight with Dexatrim. • It‟s all the nutrition her body needs and everything she wants to slide into something sexy. • The only sure way to take body fat off and keep it off is to lower your set point. And the only way to do that is aerobic exercise. 22
  • 36. 2001 • You could lose 8 to 10 pounds per week, easily, . . . and you won‟t gain the weight back afterwards. • Reduces body fat deposits in your belly, thighs and butt. • Lose up to 2 pounds daily...without diet or exercise! • A natural way to jumpstart your weight loss. • I lost 120 LBS. • Pounds come off slowly but steadily. • In six months I lost 40 pounds, and have maintained my weight for eight months. • Makes sure that the fat from your last meal leaves your body before being digested. • An intake of 4000 calories a day can actually help you lose weight instead of gain it. • The only thermogenic diet supplement that has been clinically proven to increase fat-loss by a phenomenal 38.6 times more than diet and exercise alone. • A revolutionary thermogenic diet supplement clinically shown to increase fat-loss by an astounding 17 times more than diet and exercise alone. • Weight loss breakthrough “Do you have 48 hours to lose weight?” • Lose 10 lbs. and unwanted inches in 48 hours. Guaranteed! • Can help you achieve weight loss through detoxification in just two days. • We guarantee that you‟ll lose between 2 and 8 lbs a week . . . and you won‟t put the fat back on. • I lost 68 pounds. • Clinically proven . . . uses this technology to give you a better body without spending countless hours dieting or working out. • As you‟re dieting you‟ll lose weight in the right places and drop clothes sizes without the dreaded Yo-Yo effect. • Scientifically formulated to help you achieve your weight loss goals. • By summer you can lose ten pounds (or more)! • True weight loss success occurs when you eat right. • I Cheat! Don‟t you? 23
  • 37. I learned that losing weight requires much more than just dieting - it takes a whole lifestyle change. • You could lose up to 10 lbs. this weekend! • Curbs cravings . . . reduces calorie absorption Although both the 1992 and 2001 examples include unobjectionable statements, as well as facially questionable claims, the 2001 advertisements appear to be more likely to make specific performance promises that are deceptive and misleading. For example, 31% of the 2001 ads made at least one representation that almost certainly is false, compared to zero percent in 1992. These ads appeared in Family Circle, Cosmopolitan, Women’s Day, McCall’s, and Redbook. On its face, although not conclusive, this comparison of 1992 and 2001 ads supports the following observations: C The amount of weight-loss advertising has increased dramatically since 1992. C The increase in weight-loss advertising is due to the explosion in the number of dietary supplement products now being promoted for weight loss. C The use of consumer testimonials claiming substantial, specified amounts of weight loss has increased significantly. C The use of specific performance claims, including claims that on their face are almost certainly false, has proliferated. This report looked at only specific magazines and compared only ads appearing during a four-month period in 2001 with ads appearing in the same months for 1992. Without additional supporting evidence, these results cannot be extrapolated to other forms of media. Moreover, there may be alternative explanations for the apparent increase in deceptive ads in these publications that would not necessarily mean that there has been an overall increase in deceptive weight-loss product advertising. For example, it is possible that ads have shifted from other forms of media, such as supermarket tabloids, to these magazines. Nevertheless, the observed results are consistent with the FTC staff‟s general impressions in monitoring weight loss advertising. The review set forth above suggests that weight-loss product and service advertising is permeated with false and misleading representations. Moreover, this type of advertising appears to be on the rise. At the same time, as detailed in the following section, there has been an historically unprecedented level of law enforcement aimed at preventing this type of advertising. 24
  • 38. V. Regulatory Framework The FTC and the FDA have concurrent jurisdiction over weight-loss products. The FTC has primary jurisdiction over the advertising of over-the-counter drug products, devices, and dietary supplements.43 The FDA has primary jurisdiction over the labeling of over-the-counter drug products and dietary supplements and the advertising and labeling of prescription drug products.44 A. Legal Standards Applicable to Weight-loss Advertising Under the FTC Act, the advertising of products and services for weight loss is governed by the same legal standards that apply to all other product and service promotions. The two basic principles of FTC advertising law45 are that: 1) the ad must be truthful and not misleading; and 2) before disseminating an ad, advertisers46 must have adequate substantiation for all objective product claims.47 The FTC‟s substantiation requirement applies to both express and implied claims. Thus, for example, FTC law prohibits an advertisement containing the statement that “I‟m 5' 4" and weighed 200 pounds before I started taking product X, now I weigh 110,” if supporting research does not substantiate the underlying claim that product X would enable a user to lose substantial weight, including as much as ninety pounds. The level of substantiation required depends in large part on the specific claim being made and how it is presented and qualified. For instance, an ad claiming that “Scientists Now Agree” likely would be held to a scientific consensus standard, and the advertiser would have to show that scientists in fact agree. Where no specific level of support is stated, the FTC requires “competent and reliable scientific” evidence to substantiate weight loss, and other health-related, advertising claims. In general, competent and reliable scientific evidence consists of tests, studies, or other scientific evidence that has been conducted and evaluated according to standards that experts in the field accept as accurate and reliable. Under the FTC Act, anecdotal reports, articles in popular magazines, opinions, and inadequately controlled open label studies are not considered adequate substantiation and cannot be used as substitutes for scientific support.48 Moreover, study results must be relevant to the claims being made for the product. Studies that test different ingredients or that test ingredients at a substantially different dose level than that contained in the product being marketed are not adequate substantiation. In addition, the study population and conditions of use must be consistent with the advertising claims. Studies that are limited to specific populations may not apply to other populations. Finally, if an advertisement claims that a product causes weight loss without dietary modifications, then it may not be appropriate to extrapolate results from studies using restricted caloric intake.49 B. FTC Enforcement History The FTC filed its first weight-loss case in 1927.50 The product was called McGowan‟s Reducine, and advertisements that appeared in True Romances magazine claimed that “excess fat is 25